Aier Eye Hospital of Wuhan University, Wuhan, China.
Aier Eye Hospital of Wuhan University, Wuhan, China.
J Fr Ophtalmol. 2023 Oct;46(8):929-940. doi: 10.1016/j.jfo.2023.01.030. Epub 2023 May 3.
To evaluate the safety and efficacy of atropine for childhood myopia and further explore the optimal concentration of atropine, so as to provide more reference for clinical application.
PubMed, Embase, Cochrane Library and ClinicalTrials.gov were comprehensively searched for randomized controlled trials (RCTs) up to October 14, 2021. The efficacy outcomes were progression of spherical equivalent (SE) and axial length (AL). The safety outcomes included accommodation amplitude, pupil size and adverse effects. The meta-analysis was performed using Review Manager 5.3.
Eighteen RCTs involving 3002 eyes were included. The results showed that at 6-36 months of treatment, atropine was effective in slowing the progression of myopia in children. At 12 months, the WMD of SE and AL of low-dose atropine was 0.25 diopters (D) and 0.1 millimeter (mm), moderate-dose atropine was 0.44 D and 0.16mm, high-dose atropine was 1.21 D and 0.82mm, respectively, compared with the control group. Similarly, at 24 months, low-dose atropine was 0.22 D and 0.14mm, moderate-dose atropine was 0.60 D, high-dose atropine was 0.66 D and 0.24mm, respectively. Interestingly, we also found that there was no significant difference in the effects of low-dose atropine on accommodation amplitude and photopic pupil size compared with the control group, and the rate of photophobia, allergy, blurred vision and other side effects was similar between the low-dose atropine group and the control group. In addition, atropine appears to be more effective in myopic children in China than in other countries.
Atropine in various concentrations can effectively slow myopia progression in children, and its effect is dose-dependent, while low-dose atropine (0.01% atropine) appears to be safer.
评估阿托品治疗儿童近视的安全性和有效性，并进一步探索阿托品的最佳浓度，为临床应用提供更多参考。
计算机检索 PubMed、Embase、Cochrane Library 和 ClinicalTrials.gov 数据库，搜集关于阿托品治疗儿童近视的随机对照试验（RCT），检索时限均为建库至 2021 年 10 月 14 日。对纳入文献进行质量评价后，采用 Review Manager 5.3 软件进行 Meta 分析。
共纳入 18 个 RCT，包含 3002 只眼。结果显示，6~36 个月时，阿托品治疗能有效减缓儿童近视进展。12 个月时，低浓度阿托品、中浓度阿托品和高浓度阿托品的等效球镜（SE）和眼轴（AL）的加权均数差（WMD）分别为-0.25 （D）、-0.1 （mm）、-0.44 （D）、-0.16 （mm）、-1.21 （D）、-0.82 （mm），与对照组相比差异均有统计学意义；24 个月时，低浓度阿托品、中浓度阿托品和高浓度阿托品的 SE 和 AL 的 WMD 分别为-0.22 （D）、-0.14 （mm）、-0.60 （D）、-0.66 （D）、-0.24 （mm），差异均有统计学意义。且低浓度阿托品的调节幅度和明视瞳孔直径与对照组比较，差异均无统计学意义，畏光、过敏、视物模糊等不良反应发生率与对照组比较，差异均无统计学意义。此外，在中国儿童中，低浓度阿托品的疗效似乎优于其他国家。
不同浓度的阿托品能有效减缓儿童近视进展，且效果呈剂量依赖性，而低浓度阿托品（0.01%阿托品）似乎更安全。
