0.02%和0.01%阿托品滴眼液对近视儿童散光的影响

Effects of 0.02%and 0.01%Atropine on Astigmatism in Myopic Children

目的:观察0.02%和0.01%阿托品滴眼液对近视儿童的总散光和角膜散光的影响。方法:前瞻性队列研究。收集2016年6月至2017年6月就诊于郑州大学第一附属医院的400例近视儿童,其中0.02%阿托品+框架眼镜组138例,0.01%阿托品+框架眼镜组142例,单纯框架眼镜组120例。2个阿托品组均配戴全矫单焦框架眼镜,且每晚睡前双眼同时滴用0.02%或0.01%的阿托品滴眼液;单纯框架眼镜组仅配戴全矫单焦框架眼镜。每4个月复查1次,共随访1年。采用IOLMaster测量角膜曲率;睫状肌麻痹验光获得等效球镜度数;标准矢量分析方法检测总散光和角膜散光(包括X、Y和轴向)。均选取右眼数据进行分析。采用方差分析、秩和检验和卡方检验进行数据分析。采用重复测量方差分析和广义估计方程GEE模型比较患者总散光、角膜散光以及角膜散光轴向的变化规律。结果:1年后,单纯框架眼镜组、0.01%阿托品+框架眼镜组、0.02%阿托品+框架眼镜组的总散光(包括X)均有所增加,差异有统计学意义(总散光:F时间=15.25,P=0.001;总散光X:waldχ^(2)时间=48.07,P<0.001),但3组间增加幅度基本一致,差异无统计学意义。3组的角膜散光(包括X)均逐渐增加,差异均有统计学意义(角膜散光:F时间=8.11,P=0.001;角膜散光X:waldχ^(2)时间=20.79,P<0.001),但3组间增加幅度基本一致,差异无统计学意义。随着治疗时间的延长,3组的总散光Y、角膜散光Y、总散光轴向和角膜散光轴向均稳定,且组间差异均无统计学意义。结论:近视儿童每晚规律应用0.02%或0.01%的阿托品滴眼液1年,对标准矢量分析法的总散光、角膜散光及二者的轴向均无影响。

Objective:To evaluate the effects of 0.02%and 0.01%atropine eye drops on total astigmatism and corneal astigmatism in myopic children.Methods:A prospective cohort study.The cohort study assessed 400 myopic children between June 2016 and June 2017 and divided them into three groups:138 and 142 children were randomized to use either 0.02%or 0.01%atropine eye drops,respectively.They wore singlevision spectacles(SVS),with one drop of atropine applied to both eyes once nightly.The children in the control group(n=120)only wore SVS.Spherical equivalent refractive(SE)and corneal curvature were measured every 4 months for 1 year.SE and corneal curvature were assessed by cycloplegic autorefraction and IOLMaster.Total and corneal astigmatism were calculated by standardized vector analysis and then split into its power vector components:X,Y and axes.Only the right eye was selected for data analysis.An analysis of variance test,rank sum test and Chi-square test were used for data analysis.Repeated measures analysis of variance and the generalized estimation equation GEE model were used to compare the changes in total astigmatism,corneal astigmatism and the axial changes in corneal astigmatism.Results:After 1 year,there was a small but significant increase in total astigmatism(including X),which had statistically significant differences in the 0.02%and 0.01%atropine and control groups(total astigmatism:Ftime=15.25,P=0.001;total astigmatism X:χ^(2)time=48.07,P<0.001).Total astigmatism(including X)changed at the same rate in the 3 groups,and there were nostatistically significant differences among the groups.There was a small but significant increase in corneal astigmatism(including X),which was significantly different over time in the three groups(corneal astigmatism:Ftime=8.11,P=0.001;corneal astigmatism X:χ^(2)time=20.79,P<0.001).Total astigmatism(including X)changed at the same rate in the 3 groups,and there was no statistically significant difference among the groups.There were no significant changes in the total and corneal astigmatism Y and their axes in the three groups over 1 year and the changes were not significantly different.Conclusion:Children with myopia who regularly instilled 0.02%or 0.01%atropine eye drops for 1 year showed no effect on total astigmatism,corneal astigmatism,or their axes after standardized vector analysis.