초등학교 근시 환아에서 1년 이상 경과관찰한 저농도 아트로핀 점안이 근시 진행에 미치는 영향

Effects of Low-Dose Atropine over 1 Year on Myopia Progression in Elementary School Children

목적: 초등학교(6-11세) 환자 중 1년 이상 근시로 안경을 처방받은 환자(대조군)와 저농도 아트로핀 점안한 환자(아트로핀군)의 근시진행을 비교하였다. 대상과 방법: 의무기록을 후향적으로 분석하였다. 아트로핀군은 저농도 아트로핀을 점안 후 인공누액을 양안 1회 점안하는 방법으로 매일 점안하였다. 매 방문 시 굴절력(diopters, D), 안축장 길이, 조절근점, 동공 크기를 측정하였다. 결과: 총 240명이 포함되었다. 대조군 102명, 아트로핀군 138명이었고 20.3 ± 7.8개월 경과관찰 하였다. 초진 시 대조군과 아트로핀군의 굴절력은 -4.2 ± 1.4 D, -4.8 ± 1.9 D, 안축장 길이는 24.5 ± 0.6 mm, 25.1 ± 0.9 mm였다. 최종방문 시 굴절력은 대조군 -6.1 ± 2.8 D, 아트로핀군 -5.5 ± 2.1 D였고(p < 0.01), 안축장 길이는 대조군은 26.1 ± 2.1 mm, 아트로핀군은 25.6 ± 1.0 mm였다(p < 0.01). 한 달 동안 굴절력과 안축장 길이는 대조군 -0.10 ± 0.12 D/개월, 0.06 ± 0.01 mm/개월이었고 아트로핀군 -0.03 ± 0.04 D/개월, 0.02 ± 0.02 mm/개월로 아트로핀군에서 의미 있게 낮았다(각 p < 0.01). 결론: 1년 이상 경과관찰한 저농도 아트로핀을 점안한 초등학교 근시 환자에서 굴절력 및 안축장 길이 변화가 효과적으로 억제되었다.

Purpose: To compare the myopic progression between pateints only wearing glasses (Myopia group) and patients using low-dose atropine with glasses (Atropine group) for 1 years or more. Methods: Medical records were retrospectively reviewed. Low-dose atropine (atropine sulfate 0.125%) and artificial tear eyedrops (sodium hyaluronate 0.1%) were applied immediately afterwards to both eyes daily to the Atropine group. All children regularly visited our clinic for measurement of refractive power, axial length, near-point accomodation, pupil diameter, symptoms (glare, near-work disturbance, headache, allergic reaction, dryness) were recorded. Results: A total of 240 patients were included. Atropine was prescribed for 138 patients, the Atropine group, and the remaining 102 patients constituted the Myopia group, and were observed for 20.3 ± 7.8 months. In the initial visit, the mean refractive power was -4.2 ± 1.4 diopters (D) for the Myopia group, -4.8 ± 1.9 D for the Atropine group, and the mean axial length was 24.5 ± 0.6 mm for the Myopia group, 25.1 ± 0.9 mm for the Atropine group. During follow up, in the Myopia group, mean refractive power changed -0.10 ± 0.12 D/month, and mean axial length changed 0.06 ± 0.01 mm/month. In the Atropine group, mean refractive power changed -0.03 ± 0.04 D/month, and mean axial length changed 0.02 ± 0.02 mm/month. The pupil size of the Atropine group was 6.1 ± 0.8 mm, with 30 patients presenting symptoms. Conclusions: Refractive power progression and axial length elongation was significantly lesser in the Atropine group than the Myopic group. Pupil diameter increased in the Atropine group, and 21% of the Atropine group complained of symptoms. Using low-dose atropine for more than 1 year was effective to suppress refractive power progression and axial length elongation.