0.05% atropine on control of myopia progression in Chinese school children: a randomized 3-year clinical trial

·AIM:To evaluate the effect of 0.05%atropine on the control of myopia for 2y(phase I)and on spherical equivalent refraction(SER)progression for 1y(phase II)after its withdrawal in Chinese myopic children.·METHODS:Totally 142 children with myopia were randomly assigned to the 0.05%atropine group or to the placebo group.In phase I,children received 1 treatment for each eye daily.In phase II,the patients received no treatment.Axial length(AL),SER,intraocular pressure(IOP)and atropine-related side effects were assessed at 6 months’intervals.·RESULTS:During phase I,the mean change of SER was-0.46±0.30 D in the atropine group,compared to-1.72±1.12 D in the placebo group(P<0.001).The mean change of AL in the atropine group(0.26±0.30 mm)was significantly shorter than that in the placebo group(0.76±0.62 mm,P=0.002).In addition,in phase II(12mo after the withdrawal of atropine),there was no significant difference in AL change from the atropine group,when compared with that from the placebo group(0.31±0.25 mm vs 0.28±0.26 mm,P>0.05).Furthermore,the change in SER from the atropine group was 0.50±0.41 D,which was significantly lower than 0.72±0.60 D from placebo group,(P<0.05).Finally,there were no statistically significant differences in IOP between the treatment and control groups at any stages(all P>0.05).·CONCLUSION:The use of 0.05%atropine for two consecutive years may effectively control elongation of AL and thus progression of myopia,without significant SER progression 1y after atropine withdrawal.Therefore,treatment with 0.05%atropine daily for 2y is effective and safe.

成人眼外肌术后角膜曲率及屈光状态的变化

目的:探讨成人显微眼外肌术后角膜曲率及屈光的变化。方法:选择2016-12/2017-05在云南省第二人民医院眼科行显微眼外肌术患者62例85眼,年龄18~43岁,按手术方式分为水平直肌组:Ⅰ组(单纯后徙组)32眼、Ⅱ组(单眼一条直肌后徙联合其拮抗肌截除组)34眼;斜肌组:Ⅲ组(单眼下斜肌断腱组)10眼、Ⅳ组(下斜肌转位组)9眼。分别于术前与术后1d,1wk,1、3、6mo行主观验光获得屈光度及角膜地形图采集角膜前表面(0~3、5、7mm)曲率值,比较各组内不同时间点患者屈光状态及角膜形态动态变化。结果:水平直肌术后短期可导致水平角膜曲率改变,此仅限于角膜中央5mm区内,基本在术后1mo恢复至术前水平。斜肌术后对角膜曲率无明显影响。水平直肌术后早期散光值增加,并出现近视移位,在术后1mo恢复至术前水平。斜肌术后球镜度、散光值无明显变化。结论:成人眼外肌手术后短期会出现角膜曲率及屈光变化。

角膜生物力学与光密度相关性研究

目的:探究角膜生物力学与角膜光密度的相关性。方法:前瞻性研究。选取2019-03/06在云南省第二人民医院拟行角膜屈光手术术前检查的患者为研究对象。采用Pentacam HR眼前节分析系统进行角膜光密度测量,以角膜顶点为中心,分为0~2mm、> 2~6mm、> 6~10mm直径范围3个区域,以角膜厚度分为前、中、后3层。选取Pentacam HR中角膜最薄点厚度值纳入研究。采用Corvis ST角膜生物力学分析仪测量,相关参数包括第一次压平的长度(AP1L)和速率(AP1V)、第2次压平的长度(AP2L)和速率(AP2V)、最大凹陷时顶点距离(PD)、曲率半径(HCR)和形变幅度(DA)。运用Pentacam&Corvis ST生物力学联合诊断平台软件综合分析检查结果,得出综合角膜生物力学参数(CBI)以及其它独立参数包括硬度参数(SP)、综合半径(IR)、Ambrosio相关厚度-水平方向(ARTh)、形变幅度比(DAR)。各区域光密度间差异采用方差分析,角膜生物力学各项参数与各区域光密度的相关性采用Pearson或Spearman分析。结果:不同直径范围、不同层面间光密度有差异(F=35.101,P<0.01;F=1002.897,P<0.01),CBI与独立生物力学参数中AP2L、AP2V、PD、DA、SP、IR、ARTh、DAR具有相关性(rs=-0.502,P<0.01;rs=-0.457,P=0.001;rs=0.428,P=0.002;rs=0.539,P<0.01;rs=-0.687,P<0.01;rs=0.716,P<0.01;rs=-0.728,P<0.01;rs=0.750,P<0.01)。CBI与角膜0~2mm范围内光密度呈正相关(r=0.343,P=0.015)。0~2mm范围内光密度与独立生物力学参数中AP2L、IR、ARTh、DAR有相关性(rs=-0.298,P=0.035;rs=0.368,P=0.009;rs=-0.419,P=0.002;rs=0.493,P<0.01)。结论:角膜中央区域光密度与角膜生物力学具有显著的关联,临床中可以通过光密度和生物力学对角膜健康状况进行综合评价。