短期应用1%硫酸阿托品眼用凝胶对6~7岁儿童黄斑区视网膜厚度和血管密度的影响

Effect of short-term application of 1%atropine sulfate eye gel on macular retinal thickness and vessel density in 6-7-year-old children

目的探讨6~7岁儿童短期应用1%硫酸阿托品眼用凝胶对儿童眼底黄斑区视网膜厚度和血管密度的影响。方法前瞻性非随机对照研究。选取无锡市第二人民医院眼屈光专科2019年1月至2月和2020年2月就诊的6~7岁儿童71例(71只右眼),应用1%硫酸阿托品眼用凝胶滴眼,每日2次,持续1周后停用。于用药前和用药后1、4、8周分别测量其等效球镜度(SE)、黄斑区视网膜厚度(RT)和视网膜血管密度(RVD)。根据第1周睫状肌麻痹等效球镜度(CSE)分为近视组(CSE≤-0.50 D,43眼)和对照组(CSE>-0.50 D且≤+2.00 D,28眼)。使用光相干断层扫描血管成像(OCTA)行黄斑区视网膜检测,选取以中心凹为中心,直径1 mm中心圆(Fovea)、3 mm旁中心凹环(ParaFovea)和6 mm的中心凹周边环(PeriFovea),计算Fovea和ParaFovea、PeriFovea颞侧(T)、上方(S)、鼻侧(N)、下方(I)四个象限的RT及RVD。结果两组儿童1%硫酸阿托品凝胶滴眼1周后,SE和RT均显著升高,与基线相比差异有统计学意义(均P<0.05);停药3周,近视组SE恢复至基线水平,停药7周,对照组SE和两组ParaFovea(I)区RT恢复到基线水平。近视组用药前后RVD差异均无统计学意义(均P>0.05),对照组用药1周后Fovea区RVD以及ParaFovea(I)区浅层RVD较基线时显著增加,差异有统计学意义(均P<0.05),停药后RVD下降,至第8周时,ParaFovea(N)区浅层RVD、ParaFovea(I)区深层RVD以及PeriFovea(S)区RVD较基线时降低,差异有统计学意义(均P<0.05)。用药1周后,ParaFovea(S、N、I)和PeriFovea(S)区RT变化量(ΔRT)和Fovea区RVD变化量(ΔRVD)近视组均低于对照组,差异有统计学意义(均P<0.05)。结论滴用1%硫酸阿托品眼用凝胶1周可使两组儿童黄斑区RT均显著增加,停药后恢复过程持续7周以上;可使对照组儿童Fovea区RVD以及ParaFovea(I)区浅层RVD显著增加,而对近视组儿童RVD无显著影响。

Objective To investigate the effection of short-term application of 1%atropine gel on macular retinal thickness and vessel density in 6-7-year-old children.Methods This was a prospective non-randomized controlled study.A total of 71 right eyes of 71 children from Jan.to Feb.2019 and Feb.2020 in Wuxi No.2 People’s Hospital were enrolled in this study.The 1%atropine sulfate eye gel was administered twice a day for 1 week and then stopped.Spherical equivalent(SE),macular retinal thickness(RT)and retinal vessel density(RVD)were obtained at baseline and the 1st,4th,and 8th week.Based on the cycloplegic SE(CSE)of the right eye at the 1st week,participants were divided into two groups:the myopia group(CSE≤-0.50 D,43 eyes)and the control group(CSE>-0.50 D and≤+2.00 D,28 eyes).RT and RVD of 1 mm circle(Fovea),four quadrants:temporal(T),superior(S),nasal(N)and inferior(I)of 3 mm circle ring(ParaFovea)and 6 mm circle ring(PeriFovea)were measured by using optical coherence tomography angiography(OCTA).Results In both groups,SE and RT significantly increased after administration of 1%atropine sulfate eye gel for one week(all P<0.05).SE in myopia group recovered to baseline levels 3 weeks after withdrawal,while SE in control group and RT in ParaFovea(I)in both groups recovered to baseline levels 7 weeks after withdrawal.In the myopia group,RVD had no significant change after treatment(all P>0.05).In the control group,RVD in Fovea and superficial RVD in ParaFovea(I)significantly increased at the 1st week(all P<0.05),after withdrawal RVD decreased and at the 8th week superficial RVD in ParaFovea(N),deeper RVD in ParaFovea(I)and RVD in PeriFovea(S)were significantly lower than the baseline level(all P<0.05).The change(Δ)of RT in ParaFovea(S,N and I),PeriFovea(S)andΔRVD in Fovea were significantly lower in the myopia group than those in the control group(all P<0.05).Conclusion One-week application of 1%atropine sulfate eye gel may increase RT in both groups of 6-7-year-old children,while the recovery process after withdrawal lasts more than seven weeks.And it may increase RVD in Fovea and superficial RVD in ParaFovea(I)in the control group,while has no effect on RVD in the myopia group.