Comparisons of atropine versus cyclopentolate cycloplegia in myopic children

ABSTRACT

Clinical relevance

In clinical practice, 1% atropine and 1% cyclopentolate are used as cycloplegia agents to diagnose refractive error. The influence of 1% atropine on ocular biometry is obscure, and the impact of 1% cyclopentolate remains controversial.

Background

This study aims to compare the effects of atropine versus cyclopentolate cycloplegia on ocular biometry in myopic children and to determine the sites of action for atropine.

Methods

A total of 207 myopic children aged 6–12-years were included in the analysis. All participants underwent comprehensive eye examinations before and after cyclopentolate cycloplegia, after which they were randomly assigned into two groups, A and B, in a ratio of 1:1, to receive 1% or 0.01% atropine, respectively. The treatment was administered once every night for a week. Participants were re‐examined one week later.

Results

Cyclopentolate cycloplegia caused a decrease in choroidal thickness (−3 ± 9 μm, p = 0.001), elongation of axial length (9 ± 16 μm, p < 0.001), loss of lens power (−0.14 ± 0.37 dioptre, p < 0.001), and a hyperopic shift (0.14 ± 0.22 dioptre, p < 0.001) in both groups. However, ocular biometry showed different changes after one‐week use of 1% or 0.01% atropine (all p < 0.001). In Group A, choroid thickening (24 ± 13 μm, p < 0.001) and reduced axial length (−30 ± 27 μm, p < 0.001) were observed after atropine cycloplegia, with greater changes in lens power (0.50 ± 0.37 dioptre, p < 0.001) and spherical equivalent (0.52 ± 0.23 dioptre, p < 0.001). Group B showed a slight increase in choroidal thickness following one‐week use of 0.01% atropine (6 ± 9 μm, p < 0.001), but other biometric measures showed no significant changes.

Conclusion

Cyclopentolate and atropine cycloplegia have different effects on ocular biometry. Both 1% cyclopentolate cycloplegia and 0.01% atropine resulted in choroidal thickening, indicating that the choroid may be a site of action for atropine.

KEYWORDS:

• atropine
• choroid
• cyclopentolate
• cycloplegia
• myopia

Acknowledgements

This study was funded by the National Natural Science Foundation of China (Grant No: 81703287), Shanghai Health Committee, Clinical Research (Project No. 2019240241), Shanghai Shenkang Hospital Clinical Research Program (Project No. SHDC12019X18), National Key R&D Program of China (Project No. 2016YFC0904800, 2019YFC0840607), National Science and Technology Major Project of China (Project No. 2017ZX09304010). The sponsor or funding organisation had no role in the design or conduct of this research. The following authors have no proprietary or commercial interest in any materials discussed in this article: Luyao Ye, Shanshan Li, Ya Shi, Yao Yin, Jiangnan He, Jianfeng Zhu, Xun Xu.

Additional information

Funding

National Key R&D Program of China

National Natural Science Foundation of China

National Science and Technology Major Project of China

Shanghai Health Committee, Clinical Research

Shanghai Shenkang Hospital Clinical Research Program