Yu Teng-Chieh, Wu Tzu-En, Wang Yuan-Shen, Cheng Shen-Fu, Liou Shiow-Wen
Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei.
School of Medicine, Fu Jen Catholic University, New Taipei City.
Medicine (Baltimore). 2020 Nov 25;99(48):e22745. doi: 10.1097/MD.0000000000022745.
Topical atropine has become a mainstream treatment of myopia throughout East and Southeast Asia, but it is uncertain whether long-term topical atropine therapy induces intraocular pressure (IOP) elevation and subsequent development of glaucoma. We then prospectively examined the effects of long-term atropine treatment on IOP.Our case series collected 186 myopic children who were younger than 16 years of age. Complete ocular examination data, IOP and refractive status measurements beginning in 2008 were collected for all participants. Participants were divided into two groups: 121 children who received atropine therapy at various concentrations were classified as the treated group, whereas 65 children who did not receive atropine therapy were classified as the untreated (reference) group. In the treated group, clinicians prescribed different concentrations of atropine eye drops according to their discretion with regard to the severity of myopia on each visit of the patient. We then calculated the cumulative dose of atropine therapy from 2008 to the patients' last follow-up in 2009. Furthermore, the treated group was then further divided into low- and high-refractive-error groups of nearly equal size for further analysis.There were no significant differences for the baseline refractive errors and IOPs between the treated and untreated groups. Both the low- and high-cumulative atropine dosage subgroups showed significantly lower myopic progression than the untreated group, but there was no significant difference between the two subgroups in terms of different cumulative dosages. All groups, including the untreated group, showed an increase of mean IOP at the last follow-up, but both low- and high-cumulative atropine dosage subgroups experienced a smaller increase of IOP. The mean IOP of all atropine-treated groups showed no significant increase in either low- or high-refractive-error eyes.This study revealed that topical atropine eye drops do not induce ocular hypertension and are effective for slowing the progression of myopia. The treatment effects are not correlated with the cumulative atropine dosages.
在东亚和东南亚地区，局部用阿托品已成为治疗近视的主流方法，但长期局部用阿托品治疗是否会导致眼压（IOP）升高及随后青光眼的发生尚不确定。我们随后对长期使用阿托品治疗对眼压的影响进行了前瞻性研究。我们的病例系列收集了186名16岁以下的近视儿童。收集了所有参与者自2008年开始的完整眼部检查数据、眼压和屈光状态测量结果。参与者分为两组：121名接受不同浓度阿托品治疗的儿童被归类为治疗组，而65名未接受阿托品治疗的儿童被归类为未治疗（参照）组。在治疗组中，临床医生根据每次患者就诊时近视的严重程度自行决定开具不同浓度的阿托品滴眼液。然后我们计算了从2008年到患者2009年最后一次随访时阿托品治疗的累积剂量。此外，治疗组随后又进一步分为屈光不正程度相近的低、高两组进行进一步分析。治疗组和未治疗组在基线屈光不正和眼压方面无显著差异。低累积阿托品剂量亚组和高累积阿托品剂量亚组的近视进展均显著低于未治疗组，但两个亚组在不同累积剂量方面无显著差异。所有组，包括未治疗组，在最后一次随访时平均眼压均有所升高，但低累积阿托品剂量亚组和高累积阿托品剂量亚组的眼压升高幅度较小。所有阿托品治疗组的平均眼压在低屈光不正眼和高屈光不正眼中均未显著升高。本研究表明，局部用阿托品滴眼液不会诱发高眼压，且对减缓近视进展有效。治疗效果与阿托品累积剂量无关。
