评估已发表的关于外用阿托品预防儿童近视发展的有效性和停用阿托品后近视反弹情况。
使用PubMed，EMBASE和Cohrane Library电子数据库进行荟萃分析，重点是随机对照试验(RCT)。使用的关键词是"近视"或"屈光不正"或"近视"和"阿托品"或"抗毒蕈"和"儿童"或"儿童"或"儿童"或"青少年"。末次搜索于2019年4月9日进行，Jadad评分系统用于评估每项RCT的质量。
纳入11项RCT，其中3 162例年龄在5～15岁，等效球镜为－0.50～－6.75 D。与不同对照组比较，阿托品治疗时对近视控制有益。近视发展中治疗组和对照组的平均差异为0.95 D/年[95%置信区间(CI)：0.69～1.22 ]，0.93 D/年(95%CI：0.50～1.36)，0.82 D/年(95%CI：0.68～0.96)，0.46 D/年(95%CI：－0.02～0.94)分别为1.0%、0.5%、0.1%和0.01%局部阿托品(P<0.001)。阿托品戒断12个月后，治疗期间使用的不同剂量阿托品与对照组之间的平均差异为－0.36 D/年(95%CI：－0.70～－0.02，P＝0.04，I2：98%)。
阿托品是近视控制的有效选择。阿托品治疗停止后近视有反弹，但近视进展缓慢，且低剂量阿托品(尤其是质量分数0.01%)似乎具有最小反弹效应且不良反应较少。
版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
Myopia hasbecome a global public health issue affecting a significant percentage of the population[1,2,3]. Around 1.44 billion of the people are myopic which is estimated to be equal to 22.6% of the whole world population and by 2020 the myopic population is estimated to reach around 2.5 billion[4,5]. The prevalence of myopic condition differ greatly in different geographical areas and ethnicity，whereby South Asia，East Asia and Pacific boasting the highest percentages[6].80% to 90% young adults in East Asia have myopia，and a rising trend of myopia has also been observed in western countries[7,8,9,10]. It is a serious condition in both children and adults which may lead to blindness[1,11]. The prevalence of high myopia(>－6.0 D，axial length≥26 mm) is also on rise[12]. High myopia may induce irreversible vision loss such as nuclear cataract，open angle glaucoma，peripheral retinal changes，maculopathy，choroidal neovascularization and also retinal detachment[11,13,14,15]. It has been proposed that range of factors might play a role in the development and progression of myopia[16]. The factors include genetics，insufficient near accommodation response，high AC/A ratio，esophoria，excessive near work，light levels，chromaticity of light，less time spent outdoors，magnitude of peripheral defocus and diet.Nevertheless，exact mechanism behind onset and progression of myopia is not yet fully understood[1,17,18]. More and more studies have explained the early onset of myopia in children and its increase[2,19]. Accumulative evidence suggests increasing outdoor activity and decreasing near work might be linked in supressing the progression of myopia[1,17].
