Yoo Seul Gi, Cho Myung Jin, Kim Ungsoo Samuel, Baek Seung Hee
Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea.
Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.
Korean J Ophthalmol. 2017 Jun;31(3):249-256. doi: 10.3341/kjo.2016.0007. Epub 2017 Apr 24.
To evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children.
The medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens.
A total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia.
The Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.
评估在远视儿童中，除使用1%环喷托酯外，联合使用0.5%托吡卡胺和0.5%去氧肾上腺素（托弗林，韩美制药）的睫状肌麻痹方案的有效性。
回顾性分析14岁以下接受睫状肌麻痹验光的远视患者的病历。使用两种睫状肌麻痹方案之一进行睫状肌麻痹验光。方案1是添加托弗林的方案，即先滴一滴1%环喷托酯，然后每隔15分钟添加两到三滴托弗林。方案2是仅使用环喷托酯的方案，即每隔15分钟滴三到四滴1%环喷托酯。比较两种方案中非睫状肌麻痹验光和睫状肌麻痹验光之间的平均差异。
共纳入308名远视儿童的308只眼。方案2中睫状肌麻痹验光和非睫状肌麻痹验光之间球镜等效度（SE）的平均差异（±标准差）显著大于方案1，分别为+1.70±1.03屈光度（D）和+1.25±0.89 D（p=0.001）。仅在5岁及以下患者中，两种方案睫状肌麻痹后的SE变化有显著差异（p=0.001），尤其是在SE≥5 D的高度远视患者（p=0.005）或完全调节性内斜视患者中（p=0.009）。在5岁以上患者中，无论是否存在高度远视或完全调节性内斜视，两种方案之间均无显著差异。
添加托弗林的方案产生的睫状肌麻痹效果比仅使用环喷托酯的方案弱，尤其是在患有高度远视或完全调节性内斜视的5岁以下儿童中。然而，两种方案之间的验光差异较小。添加托弗林的方案对远视儿童可能有效，且与滴入环喷托酯相比相关不适更少。
