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學校近視的藥物治療Buscopan與Neosynesine的長期治療效果
Medical Treatment of School Myopia 1. The Effect of Long Term Treatment with Buscopan and Neosynesine on Mild Myopia
並列摘要
Myopia is generally caused by variable complex factors, either congenital or acquired and both. Though numerous medicaments or medical methods have been applied in order to treat myopia, neither single nor combined method has been proved to be effective in the complete cure of the disease. But, as a we know, there is a condition which is usually called pseudomyopia. Many authors agreed that this is commonly caused by a accomodation spasm or abnormal tone of the ciliary muscles after excessive use of the eyes on a close work of long duration. Even though some disagreement has been mentioned, many still belive that it is possible to relieve its spasm or abnormal tone of the ciliary muscle and to let the eye return to its original refractive condition by using some kind of drugs or methods. Concerning the treatment of so called pseudomyopia, there are also many reports, which have been introduced by the author previously. (1) However, most of the previous papers only dealt with the effect of some drugs or methods on a small number of out patients in the hospital treated for a short duration. Furthermore, neither statistical nor objective analysis and long term observation were made in those papers. Consequently, it may be considered to be insufficient to draw a conclusion based on those results. On the other hand, it is practically impossible for patients to spend time in order to receive daily treatement of myopia at the hospital in the busy modern life, particularly for school students. Based on this reason, the author wishes to find a drug which would be safe, effective and easy to use for a long term at home. After a survey of the refraction of the primary school students, the author selected, at random, the students of 1st grade to 5th grade with mild myopia under -2.0 D (at non cycloplegic state). (The method adopted for this survey of the refraction was similiar to that of the author's previous report). (2) The students were divided into three groups and instilled with three different kinds of solutions once a day for 1 year at an intermission of one month for every three months. The drugs used were as follows: 1) 0.5% Buscopan solution for the 1st group. 2) 5% neosynesine solution for the 2nd group. 3) Normal saline solution for the 3rd group as a control. The instillation was carried out by the well trained teachers. Then, the examination of the eyes was made three times by the ophthalmologists or well trained interns who did not know the drugs applied on the students. 1) The first examination was made at the end of two weeks of treatment. 2) The second examination was made at the end of 6 month treatment with one month of intermission between two cources of the treatment (that is, at the end of 7 months from the begining of the treatment). 3) The third examination was made at the end of 1 year treatment with three intermissions between each cource of the treatment (that is, at the end of 1 year and 3 months from the begining of the treatment). Thus the following results were obtained: 1) Among 2120 eyes at the primary school students, 415 eyes (19.5%) were found to be suffered from myopia before instillation of cycloplegica and after instillation of cycloplegica (2% homatropin) only 221 eyes (10.42%) with myopia were noted. It revealed that 9.16% of the myopia were unproved by instillation of cycloplegica (These improved cases may be considered as pseudomyopia). This rate is relatively high in comparison with that of the author's previous report. Therefore, it may imply that myopia increases in its incidence among the school students in Taipei. 2) In the Neosynesine-treated group, the improvement rate was noted to be 50.4% with the average change of refractive power, +0.142D in each cases at the first examination, and at the second examination, the (improvement) rate was 54.9% with the average change of refractive power, +0.121D in each cases, whereas at the third examination, the rate was 52.6% with the average change of refractive power, -0.002 D in each cases. The differences between three rates have no significance statistically. 3) In the Buscopan-treated group, the improvement rate was noted to be 51.88% with the average change of refractive power ±0.817D in each cases at the first examination, and at the second examination, the rate was 55.9% with the average change of refractive power, +0.149D, in each cases, whereas at the third examination the rate was proved to be 60.9% with the average change of refractive power, +0.177D in each case. The differences also have no significance statistically. 4) Even in the control group applied with normal saline solution, the improvement rate was still noted to be 16.92% with the average change of refractive power, -0.038D in each case at the second examination and the rate was 31.2% with the average change of refractive power, -0.199D in each case at the third examination. As compared with other two treated groups, the differences are statistically significant. 5) In 45 cases with single eye myopia which was treated singly, 21 cases were instilled with 5% N. S. and the effective rate was 81.0%. The other 24 cases were instilled with 0.5% Bus, and the rate was found to be 87.5%. 6) The effectiveness of 5% N. S. and 0.5% Bus was noted to be more prominent in the junior classes than in the senior classes. From this fact, the treatment and prevention of myopia must be instituted as early as possible. 7) Clinically, no definite side effect after the instillation of N. S. and Bus has been noticed up to now. But further study and close observation are neceessary. 8) The effect of 0.5% Bus was slightly better than that of 5% N. S. (That is, the improvement rate was 60.9% with the average change of refractive power, +0.137D in each case at the end of the treatment with 0.5% Bus for 1 year, whereas the rate was 52.6% with the average change of refractive power, -0.002 D in each case at the same time of treatment with 5% N. S.) However, from the statistical point of view, the difference is not significant. 9) From the standpoint of the improvement of the refractive power, 25 cases (21.55%) treated with N. S. and 13 cases (14.15%) with Bus were improved more than +0.5 D in comparison with the original refractive power before the treatment at the end of 1 year treatment. The no. of cases improved more than +1.0 D was found to be 13 cases (11.5%) in the N. S. group and 4 cases (4.34%) in the Bus group, while none was improved more than ±1.0D in the control group. Furthermore, in the group with single myopia which was treated singly, the cases improved more than +0.5D as compared with the fellow eye were 9 students (20%) and those more than +1.0D improvement were 3 students (6.67%). In general, based on the above experimental results, we may conclude that Bus and N. S. seem to have some favorable effects in the treatment and prevention of pseudomyopia with rare definite clinical side effect as reported in the previous papers. Apparently, their accurate effects must be evaluated in further study. The method of instillation is rather simple, easy and suitable for long term treatment. Thus, in mild school myopia, particutarly at a early stage, the immediate institution and perfomation for a long term treatment are recommended. The treatment should be carried out or continued through out their puberty. Furthermore, during the course of the treatment, patients must be kept under strict medical supervision by ophthalmologists for detailed examination of the eye condition to prevent a development of side effect.