Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Indian J Ophthalmol. 2023 Dec 1;71(12):3633-3636. doi: 10.4103/IJO.IJO_1159_23. Epub 2023 Nov 20.
Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy.
In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland-Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted.
The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland-Altman plot revealed the limits of agreement as 1.06 and -0.71 D.
Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics.
为了了解眼睛的屈光状态，对儿童进行睫状肌麻痹验光十分必要。本研究通过视网膜镜比较了 1%环戊通和 1%阿托品的睫状肌麻痹效果。
本平行设计的干预性研究纳入了 67 名年龄在 4 至 17 岁之间的儿童。在双眼分别滴用 1%环戊通 2 次后，用 1%阿托品眼膏每日 2 次，连用 3 天，一周后重复视网膜镜检查（由同一位熟悉药物的训练有素的验光师进行）。双眼的屈光度均转换为等效球镜度（SE），并计算每个儿童双眼在每种药物下的平均值。我们使用配对 t 检验（JASP 16.4）比较 SE 值。此外，我们还进行了相关性分析，并通过 Bland-Altman 图寻找一致性。P 值 < 0.05 时表示差异有统计学意义。在可能的情况下，我们引用了 95%置信区间（CI）。
阿托品的平均 SE 值为+1.93 ± 2.0 D，而环戊通为+1.75 ± 1.95 D。平均而言，阿托品诱导的睫状肌麻痹仅增加了 0.18 D（95%CI：0.07 至 0.29 D，P 值 0.002）。两种睫状肌麻痹的相关性显著（Pearson r：0.975，P < 0.001）。Bland-Altman 图显示一致性的界限为 1.06 和-0.71 D。
我们的研究表明，环戊通在大多数情况下与阿托品一样能达到睫状肌麻痹效果。对于远视大于 5.0 D 的 15 岁以下儿童，可以考虑使用阿托品。具有起效快、作用时间短等优点的环戊通，应成为繁忙门诊的首选局部睫状肌麻痹药物。
