Schittkowski Michael P, Sturm Veit
Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, Göttingen.
Abteilung für Strabologie und Neuroophthalmologie, Kantonsspital St. Gallen, St. Gallen, Schweiz.
Klin Monbl Augenheilkd. 2018 Apr;235(4):385-391. doi: 10.1055/s-0043-121982. Epub 2017 Dec 21.
The prevalence of myopia has increased worldwide in recent decades. In East Asia's metropolises ≥ 80% of young adults are affected. This dramatic increase is mainly caused by changes in lifestyle and behaviour. Atropine has been used for more than 100 years to arrest myopia progression. It has become an evidence-based treatment regimen in the last decade, although the exact mechanism of the effect of treatment is still unknown. Atropine eye drops can slow myopia progression by an average of - 0.54 dioptres (D)/year in Asian children and - 0.35 D/year in Caucasian children. However, a non-response rate of about 10% has been found. Treatment should be established in schoolchildren only (age ≥ 6 years) with myopia ≤ - 2 D (spherical equivalent, cycoplegic refraction) and with documented myopic progression of - 0.5 D in the preceding year. 0.01% eyedrops should be instilled into the lower fornix at bedtime. Atropine 0.01% therapy is well tolerated. Atropine is usually administered for 2 years since efficacy is somewhat better in the second year. During treatment, a 6-month follow-up with cycoplegic refraction and axial length measurement is recommended. After the 2-year period, atropine withdrawal is justified if progression is less than - 0.25 D/year in the second year. Even after atropine has been stopped, follow-up examinations are needed to detect any rebound. Atropine-therapy is resumed if progression is again higher than - 0.5 D/year. Topical atropine is used off-label.
近几十年来，近视在全球范围内的患病率有所上升。在东亚的大都市中，≥80%的年轻人受到影响。这种显著增加主要是由生活方式和行为的改变引起的。阿托品已被用于阻止近视进展100多年。在过去十年中，它已成为一种循证治疗方案，尽管治疗效果的确切机制仍不清楚。阿托品滴眼液可使亚洲儿童的近视进展平均每年减缓-0.54屈光度（D），使白种儿童的近视进展平均每年减缓-0.35 D。然而，已发现约10%的无反应率。仅应在近视≤-2 D（等效球镜，睫状肌麻痹验光）且前一年有记录的近视进展为-0.5 D的学龄儿童（年龄≥6岁）中开展治疗。应在睡前将0.01%的滴眼液滴入下穹窿。0.01%阿托品治疗耐受性良好。阿托品通常给药2年，因为第二年的疗效稍好。治疗期间，建议每6个月进行一次睫状肌麻痹验光和眼轴长度测量的随访。在2年疗程后，如果第二年进展小于-0.25 D/年，则有理由停用阿托品。即使在停用阿托品后，也需要进行随访检查以检测任何反弹情况。如果进展再次高于-0.5 D/年，则恢复阿托品治疗。局部使用阿托品属于超说明书用药。
