Prousali Efthymia, Haidich Anna-Bettina, Fontalis Andreas, Ziakas Nikolaos, Brazitikos Periklis, Mataftsi Asimina
2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Aristotle University of Thessaloniki, Thessaloniki, Greece.
BMC Ophthalmol. 2019 May 9;19(1):106. doi: 10.1186/s12886-019-1112-3.
Myopia is a common visual disorder with increasing prevalence. Halting progression of myopia is critical, as high myopia can be complicated by a number of vision-compromising conditions.
Literature search was conducted in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and Centre for Reviews and Dissemination (CRD) Health Technology Assessment (HTA) database. Systematic reviews and meta-analyses investigating the efficacy and safety of multiple myopia interventions vs control conditions, were considered. Methodological quality and quality of evidence of eligible studies were assessed using the ROBIS tool and GRADE rating. The degree of overlapping of index publications in the eligible reviews was calculated with the corrected covered area (CCA).
Forty-four unique primary studies contained in 18 eligible reviews and involving 6400 children were included in the analysis. CCA was estimated as 6.2% and thus considered moderate. Results demonstrated the superior efficacy of atropine eyedrops; 1% atropine vs placebo (change in refraction: -0.78D, [- 1.30 to - 0.25] in 1 year), 0.025 to 0.05% atropine vs control (change in refraction: -0.51D, [- 0.60 to - 0.41] in 1 year), 0.01% atropine vs control (change in refraction: -0.50D, [- 0.76 to - 0.24] in 1 year). Atropine was followed by orthokeratology (axial elongation: - 0.19 mm, [- 0.21 to - 0.16] in 1 year) and novel multifocal soft contact lenses (change in refraction: -0.15D, [- 0.27 to - 0.03] in 1 year). As regards adverse events, 1% atropine induced blurred near vision (odds ratio [OR] 9.47, [1.17 to 76.78]) and hypersensitivity reactions (OR 8.91, [1.04 to 76.03]).
Existing evidence has failed to convince doctors to uniformly embrace treatments for myopic progression control, possibly due to existence of some heterogeneity, reporting of side effects and lack of long-term follow-up. Research geared towards efficient interventions is still necessary.
近视是一种常见的视力障碍，患病率呈上升趋势。阻止近视进展至关重要，因为高度近视可能会并发多种损害视力的病症。
在以下数据库进行文献检索：医学文献分析与检索系统在线数据库（MEDLINE）、医学文摘数据库（EMBASE）、Cochrane系统评价数据库（CDSR）、疗效评价文摘数据库（DARE）以及循证医学图书馆（CRD）卫生技术评估（HTA）数据库。纳入了调查多种近视干预措施与对照条件相比的疗效和安全性的系统评价和荟萃分析。使用ROBIS工具和GRADE分级评估符合条件研究的方法学质量和证据质量。用校正覆盖面积（CCA）计算符合条件的综述中索引出版物的重叠程度。
分析纳入了18篇符合条件的综述中包含的44项独特的原始研究，涉及6400名儿童。CCA估计为6.2%，因此认为重叠程度为中等。结果表明阿托品滴眼液疗效更佳；1%阿托品与安慰剂相比（1年内屈光度变化：-0.78D，[-1.30至-0.25]），0.025%至0.05%阿托品与对照相比（1年内屈光度变化：-0.51D，[-0.60至-0.41]），0.01%阿托品与对照相比（1年内屈光度变化：-0.50D，[-0.76至-0.24]）。阿托品之后是角膜塑形术（1年内眼轴伸长：-0.19mm，[-0.21至-0.16]）和新型多焦点软性接触镜（1年内屈光度变化：-0.15D，[-0.27至-0.03]）。关于不良事件，1%阿托品会导致近视力模糊（优势比[OR]9.47，[1.17至76.78]）和过敏反应（OR 8.91，[1.04至76.03]）。
现有证据未能说服医生统一采用控制近视进展的治疗方法，这可能是由于存在一些异质性、副作用报告以及缺乏长期随访。仍有必要开展针对有效干预措施的研究。
