探討點用睫狀肌麻痺劑控制近視之周邊屈光

Peripheral Refraction in Myopic Children with and without Atropine Usage

尤振宇(Jhen-You, Yu)

指導教授 ： 孫涵瑛

中山醫學大學/醫學科技學院/生物醫學科學學系碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00004

摘要

目的：睫狀肌麻痺劑常被用來控制近視進程且有多篇研究證實是有效的，但其中確切機制尚未明確。先前研究已發現正視眼和遠視眼者周邊屈光大多呈現相對性周邊近視，近視眼的患者則呈現相對周邊遠視，周邊遠視越高似乎會造成近視進程較快速，因此減少相對周邊遠視能減緩眼軸增長。本研究目的在調查點用及未點用睫狀肌麻痺劑之學童周邊屈光差異，研究睫狀肌麻痺劑是否因改變周邊屈光而達到控制近視效果，以及使用睫狀肌麻痺劑者近距離之中心與周邊調節力。
方法：受測者為台中市樹義國小及中華國小共209位學童，年齡介於6至12歲間，將其分為正視眼(0 ± 0.50 D)、低度近視(-0.51 D~-3.00D)、中度近視(-3.01D ~ -6.00D)。再各分為點用及未點用睫狀肌麻痺劑兩組，測量遠距離、近距離周邊屈光鼻側及顳側10ﾟ20ﾟ30ﾟ的差異性以及近距離周邊屈光度與調節力。
結果：結果發現在遠距離點用組大多比未點用組有更多的相對周邊近視，其中未點用組周邊遠視顯著高於點用組為：正視眼顳側30ﾟ(P=0.01)、低度近視組鼻側30ﾟ(P=0.047)及顳側30ﾟ(P=0.021)、中度近視組顳側20ﾟ(P=0.023)、顳側30ﾟ(P=0.008)及J45散光向量(P=0.007)。比較近距離相對周邊屈光發現正視眼顳側30ﾟ(P=0.049)、J0散光向量(P=0.011)、 低度近視J45散光向量(P=0.001)、中度近視鼻側20ﾟ(P=0.023)及鼻側30ﾟ(P=0.008)未點用組周邊遠視皆顯著高於點用組的。近視度數越低者周邊調節越呈現調節遲緩，在正視眼顳側30ﾟ及低度近視鼻側30ﾟ點用組周邊調節遲緩顯著多於未點用組。
結論：點用睫狀肌麻痺劑確實可以減少周邊遠視失焦，且近視度數越高者能夠減少周邊遠視量越多，特別是在周邊30ﾟ最明顯。但我們也發現點用組在看近距離時周邊會有產生較多周邊調節遲緩。本研究證實點用睫狀肌麻痺劑能改變周邊屈光狀態，這或許是點用睫狀肌麻痺劑能夠減緩近視進程的原因之一。

關鍵字

周邊屈光 ； 阿托品 ； 睫狀肌麻痺劑

並列摘要

Purpose: To compare the patterns of relative peripheral refractions, astigmatic refractions and peripheral accommodative between myopic children who are currently on atropine treatment for controlling their myopia progression and those who don’t use atropine.
Methods: Chinese children (n =209) aged 7 to 12 years participated in the study, of which 106 subjects were classified into the atropine group and 103 subjects were in the non-atropine group. According to their refractive errors, the subjects were also classified into three groups: emmetropes (SE: +0.50 to -0.50 D), low myopes (SE: -0.50 to -3.00 D) and moderate myopes (SE: -3.00 to -6.00 D). The central and peripheral refractions along the horizontal meridian (for both nasal and temporal fields) within30 degrees were measured at 4 m and 33 cm
Results: There were no statistically significant differences between the three refractive groups in the nasal and temporal retina for the spherical equivalent (SE) and astigmatism. The atropine group showed significant relative myopia in the temporal 30ﾟ field in spherical equivalent for the emmetropic group (P=0.01). In low myopic children, the atropine group had significant relative myopia in the nasal 30ﾟand temporal 30ﾟfield in spherical equivalent (P=0.047, P=0.021), and it is also observed at nasal 20ﾟ and 30ﾟin spherical equivalent and J45 astigmatism temporal field for the moderate myopic group(P=0.023, P=0.008, P=0.007). Atropine group showed significant relative myopia in the J45 astigmatism temporal 30ﾟfield and SE for the emmetropic group (P=0.011). In low myopic children, the atropine group had significant relative myopia in the J45 astigmatism temporal field (P=0.001), and it is also observed at nasal 20ﾟ and 30ﾟ field in spherical equivalent for the moderate myopic group (P=0.012, P=0.013). The atropine group showed significant relative accommodative lag in the temporal 30ﾟfield in peripheral accommodation for the emmetropic group (P=0.009). The accommodative response, the atropine group had significant relative myopia in the nasal 30ﾟ field in low myopic eye(P=0.044).
Conclusions: Significant differences between with and without atropine groups in relative peripheral refraction were found for emmetropic, low myopic and moderate myopic eyes. The present findings suggest that the eyes which received atropine may be less prolate and thus help explain the mechanism of myopia progression control in myopic children. Atropine can cause accommodative lag in emmetropic and low myopic.

並列關鍵字

peripheral refraction ； atropine

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