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Pineles, S.L., Kraker, R.T., VanderVeen, D.K., et al.




摘要:方法:旨在回顾已发表的关于阿托品用于预防儿童近视进展疗效的文献。方法:文献检索于201612月在进行,检索了PubMed数据库,没有日期限制,但仅限于英文文章,Cochrane图书馆数据库则没有任何限制。共检索出98篇引文,其中23篇全文。其中17篇文章适合纳入本次评估,随后由专家组方法学家进行评估。结果:确定了17IIIIII级研究。大多数研究报道阿托品治疗的儿童近视进展少于各个对照组。与对照组相比,主要评估近视进展的I级和II级研究中的所有8项研究显示阿托品的近视进展较少(近视进展范围从0.04±0.630.47±0.91屈光度(D/年) 0.391.19±2.48D /年)。在评估停止治疗后近视进展的研究中,注意到了反弹效应。几项研究评估了阿托品预防近视进展,治疗停止后的反弹和副作用最小化的最佳剂量。在12年的治疗期间,发现较低剂量的阿托品(0.5%,0.1%和0.01%)稍微有效,但是得出它们的反弹近视发展较少(阿托品0.01%,与阿托品0.5%,0.87±0.52D /年相比,治疗停止后平均近视发展为0.28±0.33D /年),副作用少,以及研究期后近视发展和反弹效应相似的长期结果。在亚洲人群中进行了最健全,设计最完善的研究。涉及其他种族背景患者的研究未能提供足够证据显示阿托品对近视发展的有影响。结论:I级证据支持使用阿托品来预防近视发展。尽管在治疗停止后有近视反弹的报道,但使用低剂量(尤其是阿托品0.01%)似乎可以使这种情况降至最低。

PURPOSE:To review the published literature on the efficacy of topical atropine for the prevention of myopic progression in children.METHODS:Literature searches were last conducted in December 2016 in the PubMed database with no date restrictions, but were limited to studies published in English, and in the Cochrane Library database without any restrictions. The combined searches yielded 98 citations, 23 of which were reviewed in full text. Of these, 17 articles were deemed appropriate for inclusion in this assessment and subsequently were assigned a level of evidence rating by the panel methodologist.RESULTS:Seventeen level I, II, and III studies were identified. Most of the studies reported less myopic progression in children treated with atropine compared with various control groups. All 8 of the level I and II studies that evaluated primarily myopic progression revealed less myopic progression with atropine (myopic progression ranging from 0.04±0.63 to 0.47±0.91 diopters (D)/year) compared with control participants (myopic progression ranging from 0.38±0.39 to 1.19±2.48 D/year). In studies that evaluated myopic progression after cessation of treatment, a rebound effect was noted. Several studies evaluated the optimal dosage of atropine with regard to myopic progression, rebound after treatment cessation, and minimization of side effects. Lower dosages of atropine (0.5%, 0.1%, and 0.01%) were found to be slightly less effective during treatment periods of 1 to 2 years, but they were associated with less rebound myopic progression (for atropine 0.01%, mean myopic progression after treatment cessation of 0.28±0.33 D/year, compared with atropine 0.5%, 0.87±0.52 D/year), fewer side effects, and similar long-term results for myopic progression after the study period and rebound effect were considered. The most robust and well-designed studies were carried out in Asian populations. Studies involving patients of other ethnic backgrounds failed to provide sufficient evidence of an effect of atropine on myopic progression.CONCLUSIONS:Level I evidence supports the use of atropine to prevent myopic progression. Although there are reports of myopic rebound after treatment is discontinued, this seems to be minimized by using low doses (especially atropine 0.01%).


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