比较阿托品和复方托吡卡胺对学龄期儿童散光的影响  

A Comparative Study of the Influence of Atropine and Compound Tropicamide on Astigmatism in School-Age Children

作　　者：贾桂祯 顾伟 朱娜 陈志钧[1] 李雨晴 景娇娜 Guizhen Jia;Wei Gu;Na Zhu;Zhijun Chen;Yuqing Li;Jiaona Jing(Department of Ophthalmology,Children's Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Quality Management,Children's Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属儿童医院眼科,南京210029 [2]南京医科大学附属儿童医院质量管理办公室,南京210029

出　　处：《中华眼视光学与视觉科学杂志》2022年第9期689-697,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：南京市医学科技发展项目(YKK18145);江苏省妇幼保健协会发展项目(FYX202113)。

摘　　要：目的:对6~12岁儿童使用阿托品和复方托吡卡胺麻痹睫状肌前后的散光变化进行矢量分析,探讨不同睫状肌麻痹剂对学龄期儿童散光的影响。方法:回顾性病例对照研究。收集2019年1月至2020年9月于南京医科大学附属儿童医院眼科门诊进行睫状肌麻痹验光的6~12岁儿童1262例(1262眼),按使用不同睫状肌麻痹剂分为阿托品组(530眼)和复方托吡卡胺组(732眼),均选取右眼作为研究对象。采用TOPCON KR 800型全自动电脑验光仪对所有儿童进行睫状肌麻痹前后电脑验光检查,记录球镜度、柱镜度和轴向。通过Thibos矢量分析方法将散光分解为J0和J45。睫状肌麻痹前后散光各矢量成分的差异比较采用t检验,睫状肌麻痹前后J0和J45的相关性采用Spearman相关分析,一致性采用Bland-Altman图描述。结果:复方托吡卡胺组睫状肌麻痹后J0成分增加0.04±0.13(t=8.34,P<0.001)。进一步按散光程度和SE高低分组,阿托品组睫状肌麻痹前后J0和J45差异均无统计学意义;复方托吡卡胺组J0差异在各组均有统计学意义(均P<0.001),J45仅在高度散光组及近视组差异有统计学意义(t=-2.18,P=0.031;t=-2.67,P=0.008)。Spearman相关分析发现2组睫状肌麻痹前后J0和J45相关性高,Bland-Altman分析显示2组睫状肌麻痹前后J0和J45一致性均较好。结论:与阿托品相比,滴用复方托吡卡胺进行睫状肌麻痹后散光变化显著,特别是对近视或高度散光的学龄期儿童。Objective:To investigate the influence of different cycloplegic agents on astigmatism in school-age children by comparing the vector changes of astigmatism before and after optometry in children aged 6-12 years with atropine and compound tropicamide.Methods:We conducted a retrospective cohort study of 1262 outpatients(1262 eyes),aged from 6 to 12 years,who underwent ciliary palsy optometry from January 2019 to September 2020.The patients were divided into two groups according to different cycloplegic agents,the atropine group(530 eyes)and the compound tropicamide group(732 eyes).Data of right eye of each patient was selected.The refractive measurements before and after cycloplegia were measured using an autorefractor(TOPCON KR 800)for all children,and the spherical,cylindrical and axial powers were recorded.The Thibos vector analysis method was used to decompose the astigmatism into J0 and J45.Before and after cycloplegia,data were analyzed by using t-test for the changes in astigmatism;the correlations of J0 and J45 were analyzed by Spearman's correlation coefficient,and the consistencies were described by the Bland-Altman diagram.Results:The J0 values of compound tropicamide group after cycloplegia increased by 0.04±0.13(t=8.34,P<0.001).Further grouped according to astigmatism and spherical equivalent,there was no significant difference between the J0 and J45 values between the noncycloplegia and cycloplegia in the atropine group while in the compound tropicamide group,a statistically significant difference in J0 values between noncycloplegica and cycloplegica(all P<0.001),J45 was only significant in the highly astigmatic eyes and myopic eyes(t=-2.18,P=0.031;t=-2.67,P=0.008).Spearman correlation analysis showed that high correlations of J0 and J45 values between noncycloplegia and cycloplegia in both groups.Bland-Altman analysis comparing the two methods showed a good agreement.Conclusions:Compared with atropine,there were significantly changes in astigmatism after cycloplegia refraction with compound tropicam

关 键 词：散光 睫状肌麻痹 矢量分析 学龄期儿童 

分 类 号：R778.13[医药卫生—眼科]