三种睫状肌麻痹剂对儿童调节力及屈光状态的影响
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摘要
目的
找出美多丽-P滴眼液、罗米滴眼液的最大睫状肌麻痹时间，对比美多丽-P滴眼液、罗米滴眼液、1％阿托品眼膏最大睫状肌麻痹时的剩余调节力，并分析三种药物对屈光不正检测的影响。为眼科临床合理应用睫状肌麻痹剂提供一定的实验依据。
方法
对4～16岁儿童75人、147眼进行检查，其中男32人，女43人，平均年龄10.12岁。均未曾配戴过眼镜，未曾屈光治疗，其裸眼或矫正视力均可达1.0，并除外其他眼病及影响调节的全身病。分三组：A组1％阿托品眼膏组、B组罗米滴眼液组、C组美多丽-P滴眼液组。对各组睫状肌麻痹前后不同时间点(A组涂药前及涂完药后次日；B组滴药前及滴完药后5分钟、30分钟、60分钟、90分钟、120分钟；C组滴药前及滴完药后5分钟、30分钟、60分钟、90分钟)，分别进行手持自动电脑验光仪客观验光、综合验光仪主观验光及视网膜检影验光。在综合验光仪上使用调节尺及调节卡，采用移近法测量调节力及剩余调节力。
结果
1、罗米滴眼液组最大睫状肌麻痹时间为60分钟。次日可以正常阅读。美多丽-P滴眼液组最大睫状肌麻痹时间为30分钟，次日可以正常阅读。
2、最大睫状肌麻痹时的平均剩余调节力为：1％阿托品组2.0440±0.95484D，罗米滴眼液组2.2214±0.6952D，美多丽-P滴眼液组2.6656±0.9999D。两独立样本T检验前两组无显著差异，p＞0.05。美多丽-P滴眼液组与前两组差异显著，p＜0.05，尤其近视时剩余调节力偏大。
3、三组剩余调节力均与屈光状态及年龄无关。
4、1％阿托品眼膏、罗米滴眼液、美多丽-P滴眼液三组中每组药物最
大睫状肌麻痹后，综合验光仪验光、视网膜检影结果无差别，P>0.05，都能
达到主、客观验光结果的一致性。
5、三种药各自睫状肌麻痹前后屈光度变化差值，1%阿托品眼膏组最
大，平均为0.sll0D，在远视屈光状态三组无明显差异(一0.5714-一1.
4375D)，在近视屈光状态(一0.0639一0‘3《X珍D)罗米滴眼液组较小，与
1%阿托品组相比相差小于0.25D。
结论
1、罗米滴眼液最大睫状肌麻痹时间是60分钟，美多丽一P滴眼液最大
睫状肌麻痹时间是30分钟。
2、剩余调节力1%阿托品眼膏最小，罗米滴眼液与1%阿托品眼膏相
似，美多丽一P滴眼液与前二者相比偏大。
3、美多丽一P滴眼液、1%阿托品眼膏、罗米滴眼液达到最大睫状肌麻
痹后，都能达到综合验光仪主观验光与视网膜检影客观验光结果的一致性，
都能起到充分麻痹睫状肌的作用。
4、罗米滴眼液、美多丽一P滴眼液在临床上可以作为近视儿童及无斜
视弱视的远视儿童验光的有效睫状肌麻痹剂。次日可以正常阅读，应用更
为方便。
To find out the longest effective duration of Mydrin - P and Romi eyedrop on cycloplegia, compare the residual accommodation after cycloplegia by Mydrin - P eyedrop, 1 % Atropine past and Romi eyedrop, analye their effect on ame-tropia. To provide some experiment basis for using cycloplegia properly in clinic.
Methods
75 children(147eyes) were checked , 4 ~ 16 years, male 32, female 43, mean age : 10.12 years. No organic disease. The patients divided into 3 group: A, 1 % Atropine group; B, Romi eyedrop group and C, Mydrin - P group. Before and after administration of these eyedrops, objective refrection was checked in hand -hold auto refrator; subjective refrection was checked in phoropter, and retinoscopy refraction was finished. Phoropter was used to check the accommodation response and the residual accommodation respectively by " pushup" method.
Results
1. In Romi eyedrop group , the time of maximum cycloplegia was 60 minutes , the patients can read in the next day ; In Mydrin - P group , the time
was 30 minutes , can read next day.
2. Average residual accommodation at the maximum cycloplegia: A, 1% Atropine group 2. 0440 # 0. 95484D , B, Romi eyedrop group 2. 2214 # 0. 6952D, C, Mydrin -P group 2.6656 #0.9999D. The residual accommodation in Romi eyedrop and Atropine groups has no significant difference, Independent
- samples T Test p > 0. 05. The residual accommodation in Mydrin - P group was stronger than the other two groups , more significant in myopia eyes.
3. Three groups residual accommodation have no relationship with age and refrective status.
4. The results were same in cycloplegic refraction with objective retinosco-py and subjective phoropter of each groups of A, 1 % Atropine group, B, Romi eyedrop group and C, Mydrin - P group . ( p > 0.05 )
5. Diopter difference of three group before and after cycloplegic refraction, was same in hyperopia, which of Romi eyedrop group was smaller less than 0. 25 D compared with 1% Atropine group in myopia.
Conclusions
1. The time of maximum cycloplegia effective of Romi eyedrop was 60 minutes , of Mydrin - P was 30 minutes.
2. The residual accommodation in Romi eyedrop and Atropine groups was almost same , the residual accommodation in Mydrin - P group was stronger than the other two -groups, more significant in myopia eyes.
3. There was no significant difference in the refraction change between groups before and after the administration of these 3 kinds eyedrop. They can all fully cycloplegia.
4. Romi eyedrop , Mydrin - P eyedrop can be use in the cycloplegic refraction for children in myopia and hyperopia without strabismus and amblyopia.
找出美多丽-P滴眼液、罗米滴眼液的最大睫状肌麻痹时间，对比美多丽-P滴眼液、罗米滴眼液、1％阿托品眼膏最大睫状肌麻痹时的剩余调节力，并分析三种药物对屈光不正检测的影响。为眼科临床合理应用睫状肌麻痹剂提供一定的实验依据。
方法
对4～16岁儿童75人、147眼进行检查，其中男32人，女43人，平均年龄10.12岁。均未曾配戴过眼镜，未曾屈光治疗，其裸眼或矫正视力均可达1.0，并除外其他眼病及影响调节的全身病。分三组：A组1％阿托品眼膏组、B组罗米滴眼液组、C组美多丽-P滴眼液组。对各组睫状肌麻痹前后不同时间点(A组涂药前及涂完药后次日；B组滴药前及滴完药后5分钟、30分钟、60分钟、90分钟、120分钟；C组滴药前及滴完药后5分钟、30分钟、60分钟、90分钟)，分别进行手持自动电脑验光仪客观验光、综合验光仪主观验光及视网膜检影验光。在综合验光仪上使用调节尺及调节卡，采用移近法测量调节力及剩余调节力。
结果
1、罗米滴眼液组最大睫状肌麻痹时间为60分钟。次日可以正常阅读。美多丽-P滴眼液组最大睫状肌麻痹时间为30分钟，次日可以正常阅读。
2、最大睫状肌麻痹时的平均剩余调节力为：1％阿托品组2.0440±0.95484D，罗米滴眼液组2.2214±0.6952D，美多丽-P滴眼液组2.6656±0.9999D。两独立样本T检验前两组无显著差异，p＞0.05。美多丽-P滴眼液组与前两组差异显著，p＜0.05，尤其近视时剩余调节力偏大。
3、三组剩余调节力均与屈光状态及年龄无关。
4、1％阿托品眼膏、罗米滴眼液、美多丽-P滴眼液三组中每组药物最
大睫状肌麻痹后，综合验光仪验光、视网膜检影结果无差别，P>0.05，都能
达到主、客观验光结果的一致性。
5、三种药各自睫状肌麻痹前后屈光度变化差值，1%阿托品眼膏组最
大，平均为0.sll0D，在远视屈光状态三组无明显差异(一0.5714-一1.
4375D)，在近视屈光状态(一0.0639一0‘3《X珍D)罗米滴眼液组较小，与
1%阿托品组相比相差小于0.25D。
结论
1、罗米滴眼液最大睫状肌麻痹时间是60分钟，美多丽一P滴眼液最大
睫状肌麻痹时间是30分钟。
2、剩余调节力1%阿托品眼膏最小，罗米滴眼液与1%阿托品眼膏相
似，美多丽一P滴眼液与前二者相比偏大。
3、美多丽一P滴眼液、1%阿托品眼膏、罗米滴眼液达到最大睫状肌麻
痹后，都能达到综合验光仪主观验光与视网膜检影客观验光结果的一致性，
都能起到充分麻痹睫状肌的作用。
4、罗米滴眼液、美多丽一P滴眼液在临床上可以作为近视儿童及无斜
视弱视的远视儿童验光的有效睫状肌麻痹剂。次日可以正常阅读，应用更
为方便。
To find out the longest effective duration of Mydrin - P and Romi eyedrop on cycloplegia, compare the residual accommodation after cycloplegia by Mydrin - P eyedrop, 1 % Atropine past and Romi eyedrop, analye their effect on ame-tropia. To provide some experiment basis for using cycloplegia properly in clinic.
Methods
75 children(147eyes) were checked , 4 ~ 16 years, male 32, female 43, mean age : 10.12 years. No organic disease. The patients divided into 3 group: A, 1 % Atropine group; B, Romi eyedrop group and C, Mydrin - P group. Before and after administration of these eyedrops, objective refrection was checked in hand -hold auto refrator; subjective refrection was checked in phoropter, and retinoscopy refraction was finished. Phoropter was used to check the accommodation response and the residual accommodation respectively by " pushup" method.
Results
1. In Romi eyedrop group , the time of maximum cycloplegia was 60 minutes , the patients can read in the next day ; In Mydrin - P group , the time
was 30 minutes , can read next day.
2. Average residual accommodation at the maximum cycloplegia: A, 1% Atropine group 2. 0440 # 0. 95484D , B, Romi eyedrop group 2. 2214 # 0. 6952D, C, Mydrin -P group 2.6656 #0.9999D. The residual accommodation in Romi eyedrop and Atropine groups has no significant difference, Independent
- samples T Test p > 0. 05. The residual accommodation in Mydrin - P group was stronger than the other two groups , more significant in myopia eyes.
3. Three groups residual accommodation have no relationship with age and refrective status.
4. The results were same in cycloplegic refraction with objective retinosco-py and subjective phoropter of each groups of A, 1 % Atropine group, B, Romi eyedrop group and C, Mydrin - P group . ( p > 0.05 )
5. Diopter difference of three group before and after cycloplegic refraction, was same in hyperopia, which of Romi eyedrop group was smaller less than 0. 25 D compared with 1% Atropine group in myopia.
Conclusions
1. The time of maximum cycloplegia effective of Romi eyedrop was 60 minutes , of Mydrin - P was 30 minutes.
2. The residual accommodation in Romi eyedrop and Atropine groups was almost same , the residual accommodation in Mydrin - P group was stronger than the other two -groups, more significant in myopia eyes.
3. There was no significant difference in the refraction change between groups before and after the administration of these 3 kinds eyedrop. They can all fully cycloplegia.
4. Romi eyedrop , Mydrin - P eyedrop can be use in the cycloplegic refraction for children in myopia and hyperopia without strabismus and amblyopia.
引文
1．李风鸣，眼科全书，北京，人民卫生出版社，1996，2622-2640
2. Gettes BC. Drugs in refraction Int Ophthalmol Clin. 1961;1:237-248
3. Risley SD. The comparative value of the mydriatics. Trans Am Ophthalmol Soc. 1881;3:228-243
4. Rutb E. Manny, et, Tropicamide (1%):An Effective Cycloplegie Agent for Myopic Children, IOVS, July 2001, Vol. 42, No. 8
5. Twelker JD, et, Retinoscopy in infents using a near noncycloplegic technique, cycloplegia with tyopicamide 1%, and cycloplegia with cyclopentolatel%, Optom Vis Sci 2001 Apr;78 (4):215-22
6. Lin LL, et, The cycloplegic effects of cyclopentolate and tropicamide on myopic children, J Ocul Pharmacol Ther 1998 Aug;14(4):331-5
7. Egashira SM, et, Comparison of cyclopentolate versus tropicamide cycloplegia in children,Optom Vis Sci 1993 dec;70(12):1019-26
8. Celebi S, et, The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia of retinoscopy, autorefractometry and biometric lens thickness. Acta Ophthalmol Stand 1999 Aug;77 (4):426-9
9．卢炜，三种睫状肌麻痹剂在学龄儿童验光中的作用评估，北京医学，1997；19(4)：236
10. Kleinstein RN, et, Cycloplegia in African-American children, Optom Vis Sci 1999 Feb;76(2):102-7
11. Alimgil ML, et, The cycloplegic effect of atropine in comparison with the cyclopentolate-tropicamide-phenylephrine combination, KlinMonasbl Augenheilkd 1992 Jul; 201 (1):9-11
12. Mutti DO, et, The effect of cycloplegia on measurement of the ocular components, Invest Ophthaimol Vis Sci 1994 Feb;35 (2):515-27
13. Lovasik JV, et, Time course of cycloplegia induced by a new phenylephrine-tropicamide combination drug,Optom Vis Sci 1990 May;67(5):352-8
14. Stolovitch C, et, Atropine cycloplegia:how many instillations dose one need?, J Pediatr Ophthalmol Strabismus 1992 May-Jun;29 (3):175-6
15. Hunold W, et, Refraction by atropine cycloplegia, Ophthalmologica 1991; 201 (1):26-32
16. Auffarth g, et Cycloplegic refraction in children: single-dose-atropinization versus three-day-atropinization, Doc Ophthalmol 1992; 80 (4) 353-62
17．惠延年，眼科学，北京，人民卫生出版社，2001，167
18．高前应等，正视和近视儿童的张力性调节的两种测定方法比较，中国斜视与小儿眼科杂志，1999；7(4)：164-167
19．刘汉强等，阿托品麻痹小儿睫状肌效果的动态观察，实用眼科杂志1992；10(7)：420-424
20．宋玉伟，托比卡胺麻痹小儿睫状肌的动态观察，华西医学，1996；12(4)：498-499
21. Manny RE, et, 1% Cyclopentolate hydrochloride: another look at the time course of cycloplegia using an objective measure of the accommodative response,Optom vis Sci,1993 Aug;70(8):651-652
22．刘克高等，调节功能的某些研究进展，中国斜视与小儿眼科杂志，1994；2(4)：183-187
23. Chat SW, Edwards MH, Clinical evaluation of the Shin-Nippon SRW_5000 autorefractor in children, Ophthalmic Physiol Opt 2000 Mar; 21 (2):87-100
24. Gettes BC. Tropicamide, a new cycloplegic mydriatic. Arch Ophthalmol. 161;65:632-635
25. Rosernfield M, Linfield PB, A comparison of the effects of cycloplegics on accommodation ability for distance vison and on the apparent near point. Ophthalmol Physiol Opt. 1986;6:317-320
2. Gettes BC. Drugs in refraction Int Ophthalmol Clin. 1961;1:237-248
3. Risley SD. The comparative value of the mydriatics. Trans Am Ophthalmol Soc. 1881;3:228-243
4. Rutb E. Manny, et, Tropicamide (1%):An Effective Cycloplegie Agent for Myopic Children, IOVS, July 2001, Vol. 42, No. 8
5. Twelker JD, et, Retinoscopy in infents using a near noncycloplegic technique, cycloplegia with tyopicamide 1%, and cycloplegia with cyclopentolatel%, Optom Vis Sci 2001 Apr;78 (4):215-22
6. Lin LL, et, The cycloplegic effects of cyclopentolate and tropicamide on myopic children, J Ocul Pharmacol Ther 1998 Aug;14(4):331-5
7. Egashira SM, et, Comparison of cyclopentolate versus tropicamide cycloplegia in children,Optom Vis Sci 1993 dec;70(12):1019-26
8. Celebi S, et, The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia of retinoscopy, autorefractometry and biometric lens thickness. Acta Ophthalmol Stand 1999 Aug;77 (4):426-9
9．卢炜，三种睫状肌麻痹剂在学龄儿童验光中的作用评估，北京医学，1997；19(4)：236
10. Kleinstein RN, et, Cycloplegia in African-American children, Optom Vis Sci 1999 Feb;76(2):102-7
11. Alimgil ML, et, The cycloplegic effect of atropine in comparison with the cyclopentolate-tropicamide-phenylephrine combination, KlinMonasbl Augenheilkd 1992 Jul; 201 (1):9-11
12. Mutti DO, et, The effect of cycloplegia on measurement of the ocular components, Invest Ophthaimol Vis Sci 1994 Feb;35 (2):515-27
13. Lovasik JV, et, Time course of cycloplegia induced by a new phenylephrine-tropicamide combination drug,Optom Vis Sci 1990 May;67(5):352-8
14. Stolovitch C, et, Atropine cycloplegia:how many instillations dose one need?, J Pediatr Ophthalmol Strabismus 1992 May-Jun;29 (3):175-6
15. Hunold W, et, Refraction by atropine cycloplegia, Ophthalmologica 1991; 201 (1):26-32
16. Auffarth g, et Cycloplegic refraction in children: single-dose-atropinization versus three-day-atropinization, Doc Ophthalmol 1992; 80 (4) 353-62
17．惠延年，眼科学，北京，人民卫生出版社，2001，167
18．高前应等，正视和近视儿童的张力性调节的两种测定方法比较，中国斜视与小儿眼科杂志，1999；7(4)：164-167
19．刘汉强等，阿托品麻痹小儿睫状肌效果的动态观察，实用眼科杂志1992；10(7)：420-424
20．宋玉伟，托比卡胺麻痹小儿睫状肌的动态观察，华西医学，1996；12(4)：498-499
21. Manny RE, et, 1% Cyclopentolate hydrochloride: another look at the time course of cycloplegia using an objective measure of the accommodative response,Optom vis Sci,1993 Aug;70(8):651-652
22．刘克高等，调节功能的某些研究进展，中国斜视与小儿眼科杂志，1994；2(4)：183-187
23. Chat SW, Edwards MH, Clinical evaluation of the Shin-Nippon SRW_5000 autorefractor in children, Ophthalmic Physiol Opt 2000 Mar; 21 (2):87-100
24. Gettes BC. Tropicamide, a new cycloplegic mydriatic. Arch Ophthalmol. 161;65:632-635
25. Rosernfield M, Linfield PB, A comparison of the effects of cycloplegics on accommodation ability for distance vison and on the apparent near point. Ophthalmol Physiol Opt. 1986;6:317-320