目的观察质量分数0.01%阿托品滴眼液对青少年近视患者眼部生物学参数的影响。
方法采用前瞻性队列研究，收集2016年6月至2017年6月就诊于郑州大学第一附属医院并按时完成1年随访的青少年近视患者219例，按照受试者及监护人意愿分为2个组，其中0.01%阿托品+框架眼镜组119例均配戴全矫单焦框架眼镜，且每晚睡前双眼点用0.01%阿托品滴眼液；单纯框架眼镜组100例仅配戴全矫单焦框架眼镜。采用IOL Master测量眼轴长度(AL)、角膜屈光力和前房深度；依据Bennett-Rabbetts公式计算晶状体屈光力；采用非接触式眼压计测量眼压；睫状肌麻痹验光获得近视等效球镜度(SE)；总散光和角膜散光由矢量分解计算获得。均选取右眼数据进行分析，比较2个组眼部生物学参数的变化规律，采用多重线性回归分析评估近视患者SE变化量的影响因素。
结果治疗后12个月，0.01%阿托品+框架眼镜组SE变化量和AL增加量分别为(－0.47±0.45)D和(0.37±0.22)mm，小于单纯框架眼镜组的(－0.70±0.60)D和(0.46±0.35)mm，差异均有统计学意义(t＝5.523、9.651，均P<0.001)。2个组治疗前后不同时间点SE和AL总体比较，差异均有统计学意义(SE：F组别＝1.556，P＝0.015；F时间＝12.538，P＝0.002；AL：F组别＝3.425，P＝0.021；F时间＝18.235，P＝0.008)，其中治疗后4、8和12个月，2个组SE和AL均较各自治疗前增加，差异均有统计学意义(均P<0.001)。治疗后8个月和12个月，0.01%阿托品+框架眼镜组SE和AL均小于单纯框架眼镜组，差异均有统计学意义(均P<0.001)。治疗后8个月和12个月，2个组总散光和前房深度均较治疗前增加，晶状体屈光力均较治疗前减小，差异均有统计学意义(均P<0.05)。2个组治疗前后不同时间点角膜散光、角膜屈光力、眼压总体比较差异均无统计学意义(均P>0.05)。多重线性回归模型中，Δ近视SE＝－0.012－2.685×ΔAL－1.002×Δ角膜屈光力－0.656×Δ晶状体屈光力+0.477×Δ总散光+0.363×Δ前房深度－0.060×年龄+0.011×性别，近视SE变化量主要由AL变化量引起(β＝－2.685)，其次是角膜屈光力、晶状体屈光力、总散光和前房深度变化量。
结论0.01%阿托品滴眼液可有效控制青少年近视患者度数进展和眼轴增长，对散光、角膜屈光力、晶状体屈光力、前房深度和眼压均无明显影响，其主要是通过延缓眼轴增长来控制近视度数的进展。
ObjectiveTo observe the effects of 0.01% atropine eye drops on ocular biometrics in myopic adolescents.
MethodsA prospective cohort study was conducted.Two hundred and nineteen myopic adolescents who visited the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2017 and completed the 1-year follow-up on time were enrolled.The 219 adolescents were divided into a 0.01% atropine+ single-vision spectacles (SV) group (119 cases) wearing single-vision spectacles with one drop of atropine eye drop applied to both eyes once nightly, and a simple SV group (100 cases) wearing SV only.Axial length (AL), corneal power and anterior chamber depth were measured with the IOLMaster.Lens power was calculated using the Bennett-Rabbetts formula.Intraocular pressure was measured by non-contact tonometry.Spherical equivalent (SE) was examined by cycloplegic autorefraction.Total astigmatism and corneal astigmatism were calculated by vector decomposition.The right eye data were analyzed to compare the ocular biometrics changes between the two groups, and multiple linear regression analysis was used to evaluate the influencing factors.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of First Affiliated Hospital of Zhengzhou University (No.2016-35). Written informed consent was obtained from guardians before any medical examination.
ResultsThe SE change and AL elongation 12 months after treatment in 0.01% atropine+ SV group were (-0.47±0.45) D and (0.37±0.22) mm, respectively, which were significantly lower than (-0.70±0.60)D and (0.46±0.35)mm in simple SV group (t=5.523, 9.651; both at P<0.001). There were significant differences in SE and AL between before and after treatment in both groups (SE:Fgroup=1.556, P=0.015; Ftime=12.538, P=0.002; AL: Fgroup=3.425, P=0.021; Ftime=18.235, P=0.008). The SE and AL at 4, 8 and 12 months after treatment were all increased in comparison with before treatment in both groups, showing statistically significant differences (all at P<0.001). The SE and AL at 8 and 12 months after treatment in 0.01% atropine+ SV group were smaller than in simple SV group, and the differences were statistically significant (all atP<0.001). At 8 and 12 months after treatment, total astigmatism and the anterior chamber depth were increased and the lens power was decreased in comparison with before treatment in both groups, and the differences were statistically significant (all atP<0.05). There was no significant difference in corneal astigmatism, corneal power and intraocular pressure at different time points before and after treatment between the two groups (all atP>0.05). In the multiple linear regression analysis, an equation of Δmyopic SE=-0.012-2.685×ΔAL-1.002×Δcorneal astigmatism-0.656×Δlens power+ 0.477×Δtotal astigmatism+ 0.363×Δanterior chamber depth-0.060×age+ 0.011×sex was used, showing the change of SE was mainly caused by the change of AL (β=-2.685), then corneal power, lens power, total astigmatism and anterior chamber depth.
ConclusionsIn adolescents, 0.01% atropine eye drops can effectively retard myopia progression and axial elongation, showing no effect on astigmatism, corneal power, lens power, anterior chamber depth and intraocular pressure.The controlling effect of 0.01% atropine eye drops in the development of myopia is mainly achieved by reducing axial elongation.
崔璨,符爱存,魏丽,等. 0.01%阿托品滴眼液对青少年近视患者眼部生物学参数的影响[J]. 中华实验眼科杂志,2023,41(04)：330-337.
DOI:10.3760/cma.j.cn115989-20210207-00100版权归中华医学会所有。
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崔璨：参与选题、酝酿和设计试验、实施研究、采集数据、分析/解释数据、起草文章、对文章知识性内容的审阅和智力性内容的修改及定稿；符爱存：参与选题、酝酿和设计试验、实施研究、对文章知识性内容的审阅和智力性内容的修改及定稿；魏丽：分析/解释数据；赵兵新：实施研究；于世傲：实施研究、采集数据、对文章知识性内容的审阅和智力性内容的修改及定稿；张俊杰、王卫群：参与选题、酝酿和设计试验；吕勇：参与选题、酝酿和设计试验、对文章知识性内容的审阅和智力性内容的修改及定稿；李秀娟：参与选题、酝酿和设计试验、实施研究、分析/解释数据、起草文章、对文章知识性内容的审阅和智力性内容的修改及定稿
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