Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, 970, Taiwan.
J Formos Med Assoc. 2022 Dec;121(12):2490-2500. doi: 10.1016/j.jfma.2022.05.005. Epub 2022 Jun 7.
BACKGROUND/PURPOSE: Orthokeratology (Ortho-K), atropine eye drops and combined atropine with Ortho-K are proven to be effective ways to prevent myopic progression in many studies, but there is scarce evidence regarding the comparative efficacy of different dosages of atropine,Ortho-K, and combined atropine with Ortho-K for childhood myopia.
We performed a network meta-analysis (NMA) to assess the relative efficacy of the aforementioned interventions for myopic progression; moreover, we calculated the surface under cumulative ranking area (SUCRA) to determine the relative ranking of treatments.
We identified 19 randomized controlled trials (3435 patients). NMA revealed that 0.01%-1% atropine, Ortho-K, and 0.01% atropine combined with Ortho-K inhibited axial elongation (AL) over one year. For refractive change, SUCRA analysis revealed that the hierarchy was high-dose (0.5%-1%), moderate-dose (0.1%-0.25%), and low-dose (0.01%-0.05%) atropine. Regarding AL, SUCRA analysis revealed the following hierarchy: Ortho-K combined with 0.01% atropine, high-dose atropine, moderate-dose atropine, Ortho-K, and low-dose atropine.
In conclusion, we found that atropine (0.01%-1%), Ortho-K, and 0.01% atropine combined with Ortho-K could significantly slow down myopia progression. The atropine efficacy followed a dose-related pattern; moreover, Ortho-K and low-dose atropine showed similar efficacy. There was a synergistic effect of using 0.01% atropine combined with Ortho-K, and it showed comparable efficacy to that of high-dose atropine.
背景/目的：多项研究证明，角膜塑形术（Ortho-K）、阿托品滴眼液以及阿托品联合 Ortho-K 是预防近视进展的有效方法，但对于不同剂量的阿托品、Ortho-K 以及阿托品联合 Ortho-K 治疗儿童近视的相对疗效，证据有限。
我们进行了一项网络荟萃分析（NMA），以评估上述干预措施对近视进展的相对疗效；此外，我们计算了累积排序曲线下面积（SUCRA），以确定治疗方法的相对排名。
我们共确定了 19 项随机对照试验（3435 名患者）。NMA 结果显示，0.01%-1%阿托品、Ortho-K 和 0.01%阿托品联合 Ortho-K 在一年时间内均可抑制眼轴延长（AL）。对于屈光度变化，SUCRA 分析结果显示，高剂量（0.5%-1%）、中剂量（0.1%-0.25%）和低剂量（0.01%-0.05%）阿托品的排序较高。就 AL 而言，SUCRA 分析结果显示，以下治疗方法的排序较高：0.01%阿托品联合 Ortho-K、高剂量阿托品、中剂量阿托品、Ortho-K 和低剂量阿托品。
总之，我们发现阿托品（0.01%-1%）、Ortho-K 和 0.01%阿托品联合 Ortho-K 可显著减缓近视进展。阿托品的疗效呈剂量相关模式；此外，Ortho-K 和低剂量阿托品的疗效相当。0.01%阿托品联合 Ortho-K 具有协同作用，其疗效与高剂量阿托品相当。
