Eyeson-Annan M L, Hirst L W, Battistutta D, Green A
West Moreton Public Health Unit, Queensland Health, Ipswich, Australia.
Ophthalmology. 1998 Apr;105(4):726-32. doi: 10.1016/S0161-6420(98)94030-1.
A prevalence survey of actinic and other eye diseases was conducted in Nambour, Queensland, Australia, in 1992. Pupils were dilated with phenylephrine alone for cataract identification because there were concerns that patient discomfort, due to cycloplegia occurring with the usual dilating agents of tropicamide and phenylephrine, may influence future compliance in an associated intervention study. This validation study was undertaken to measure the possible underestimation of cataract prevalence in this community study, which may have occurred because of inadequate dilation from phenylephrine alone.
The study design was a repeated measures experimental design.
Forty-seven normal subjects participated in the study. Both eyes were tested.
Pupil diameter after dilation with three drops of 10% phenylephrine alone was compared with pupil diameter after dilation with three drops of 10% phenylephrine together with three drops of 1% tropicamide. The two regimens were given to the same subjects 1 week apart. Reversal was attempted with thymoxamine hydrochloride 0.5%.
Pupil diameter was assessed using a Neitz cataract camera, and accommodation reserve also was measured. Subjects' subjective appreciation of return of ocular function was assessed by a questionnaire. Repeated measures analysis of variance, paired t test, McNemar's test, and Wilcoxon signed rank test were used to analyze outcomes.
Mean maximum pupil size with 10% phenylephrine and 1% tropicamide was significantly larger than pupil size after the use of 10% phenylephrine alone (F1,19 = 18.99, P = 0.0003). However, there was no significant difference between the two dilation regimens when comparing the proportion of subjects who dilated to 6 mm or more (McNemar's X(2)1 = 2.7, P > 0.1). Compared with 10% phenylephrine and 1% tropicamide, pupil diameters were significantly smaller (t46 = 16.77, P = 0.0001), and accommodation reserve greater (t46 = 4.14, P = 0.0001), 40 minutes after reversal with thymoxamine in the group dilated with 10% phenylephrine alone.
Pupil dilation with 10% phenylephrine alone, if allowed at least 40 minutes to act, will be as satisfactory for the identification of cataracts in a normal population as 10% phenylephrine and 1% tropicamide and is more acceptable because of reduced problems with glare and accommodation.
1992年在澳大利亚昆士兰州楠伯尔开展了一项关于光化性眼病及其他眼病的患病率调查。仅用去氧肾上腺素散瞳以鉴别白内障，因为担心常用散瞳剂托吡卡胺和去氧肾上腺素引起的睫状肌麻痹会导致患者不适，这可能会影响相关干预研究中患者未来的依从性。开展这项验证性研究是为了评估在该社区研究中白内障患病率可能因仅用去氧肾上腺素散瞳不足而被低估的情况。
研究设计为重复测量实验设计。
47名正常受试者参与了研究。对双眼进行了检测。
比较仅滴3滴10%去氧肾上腺素散瞳后的瞳孔直径与滴3滴10%去氧肾上腺素加3滴1%托吡卡胺散瞳后的瞳孔直径。两种用药方案在相隔1周的时间给予同一受试者。尝试用0.5%盐酸噻吗洛尔进行缩瞳。
使用尼康白内障相机评估瞳孔直径，并测量调节储备。通过问卷调查评估受试者对眼功能恢复的主观感受。采用重复测量方差分析、配对t检验、McNemar检验和Wilcoxon符号秩检验分析结果。
10%去氧肾上腺素加1%托吡卡胺散瞳后的平均最大瞳孔尺寸显著大于仅使用10%去氧肾上腺素后的瞳孔尺寸（F1,19 = 18.99，P = 0.0003）。然而，比较散瞳至6mm或更大的受试者比例时，两种散瞳方案之间无显著差异（McNemar检验X(2)1 = 2.7，P > 0.1）。与10%去氧肾上腺素加1%托吡卡胺相比，仅用10%去氧肾上腺素散瞳的组在用0.5%盐酸噻吗洛尔缩瞳40分钟后，瞳孔直径显著更小（t46 = 16.77，P = 0.0001），调节储备更大（t46 = 4.14，P = 0.0001）。
仅用10%去氧肾上腺素散瞳，若给予至少40分钟起效时间，对于正常人群白内障的鉴别与10%去氧肾上腺素加1%托吡卡胺同样令人满意，且因眩光和调节问题减少而更易被接受。
