Department of Pharmacology and Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Ocul Pharmacol Ther. 2011 Aug;27(4):361-8. doi: 10.1089/jop.2011.0017. Epub 2011 Jun 7.
Myopia is the most common ocular disorder associated with increasing risk for chorioretinal degeneration, retinal detachment, and other vision-threatening abnormalities worldwide. Recently, atropine has been becoming a focus of attention due to its role in ameliorating the myopia progression in children. This meta-analysis was conducted to address the efficacy and safety of atropine on myopia in children and the dose-response relationship between atropine and annual rate of myopia progression.
Controlled clinical trials were retrospectively analyzed to compare atropine and placebo for the treatment of myopia. The primary outcome measure was annual rate of myopia progression after daily atropine application over 1 year. Data were extracted from 6 randomized clinical trials and analyzed using standard meta-analysis and meta-regression methods.
Comparing with placebo, the effect size of atropine for retarding myopia progression was 0.773 diopters (D)/year [95% confidence interval (CI): 0.699-0.848]. Regression model, -0.728+1.281log (dose+1), revealed the dose-response relationship between atropine and myopia progression. The estimate of effect for 0.05%, 0.1%, and 0.25% atropine was -0.665 (95% CI: -1.070 to -0.260), -0.606 (95% CI: -0.967 to -0.245), and -0.442 (95% CI: -0.701 to -0.183) D/year respectively, whereas that for 0.5% and 1% was -0.208 (95% CI: -0.435-0.018) and 0.160 (95% CI: -0.293-0.613), respectively, suggesting that myopia might deteriorate at low dose of atropine but not at 0.5% atropine and 1% atropine within the duration of 6-24 months. No serious adverse event was reported during the period of treatment. The major adverse reactions associated with 0.5% and 1% atropine were photophobia, glare, and recurrent allergic blepharitis. Photochromatic lenses or sunglasses with ultraviolet protection could be used to minimize the glare and photophobia.
In summary, 0.5% and 1% atropine was demonstrated to be effective and safe to ameliorate myopia progression in childhood with low-to-moderate myopia.
近视是最常见的眼部疾病，与全球范围内脉络膜视网膜变性、视网膜脱离和其他威胁视力的异常风险增加有关。最近，阿托品由于其在减缓儿童近视进展方面的作用而受到关注。本荟萃分析旨在探讨阿托品治疗儿童近视的疗效和安全性，以及阿托品与近视年进展率之间的剂量-反应关系。
回顾性分析对照临床试验，比较阿托品与安慰剂治疗近视。主要观察指标为每日应用阿托品治疗 1 年后的近视年进展率。从 6 项随机临床试验中提取数据，并采用标准荟萃分析和荟萃回归方法进行分析。
与安慰剂相比，阿托品延缓近视进展的效果大小为 0.773 屈光度（D）/年[95%置信区间（CI）：0.699-0.848]。回归模型-0.728+1.281log（剂量+1）显示了阿托品与近视进展之间的剂量-反应关系。0.05%、0.1%和 0.25%阿托品的效应估计值分别为-0.665（95%CI：-1.070 至-0.260）、-0.606（95%CI：-0.967 至-0.245）和-0.442（95%CI：-0.701 至-0.183）D/年，而 0.5%和 1%的估计值分别为-0.208（95%CI：-0.435-0.018）和 0.160（95%CI：-0.293-0.613），这表明在 6-24 个月的治疗期间，低剂量的阿托品可能会使近视恶化，但 0.5%的阿托品和 1%的阿托品不会。在治疗期间未报告严重不良事件。与 0.5%和 1%阿托品相关的主要不良反应是畏光、眩光和复发性过敏性睑缘炎。可以使用光致变色镜片或具有紫外线防护功能的太阳镜来最小化眩光和畏光。
总之，0.5%和 1%的阿托品被证明对治疗中低度近视的儿童近视进展有效且安全。
