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Comparative study on the safety and efficacy of different cycloplegic agents in children with darkly pigmented irides
Dorothy S P Fan1, Srinivas K Rao, Joan S K Ng
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong. dorothyfan@cuhk.edu.hk
Insights
For hyperopic children, a combination of tropicamide 0.5% and phenylephrine 0.5% (regimen I) proved as effective as tropicamide 1.0% and cyclopentolate 1.0% (regimen II) in older children, avoiding potential cyclopentolate toxicity.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Pharmacology
Background:
- The absence of an ideal cycloplegic drug for children necessitates research into safe and effective alternatives.
- Hyperopic children with pigmented irides pose unique challenges for cycloplegic drug efficacy.
Purpose of the Study:
- To assess the safety and efficacy of three distinct cycloplegic regimens in pediatric patients with hyperopia.
- To compare cycloplegia responses across different age groups and in the presence of strabismus.
Main Methods:
- A crossover study design evaluated tropicamide 0.5%/phenylephrine 0.5% (regimen I), tropicamide 1.0%/cyclopentolate 1.0% (regimen II), and atropine 1.0% (regimen III) in 25 children.
- Cycloplegic refractions were measured to determine refractive error under cycloplegia.
Main Results:
- All three regimens produced statistically significant cycloplegic refractions compared to manifest refractions (P < 0.001).
- Regimen I and II showed no significant difference in efficacy for children older than 5 years or those without strabismus (P > 0.050).
- Mean spherical equivalent refractions were +5.11 D (regimen I), +5.29 D (regimen II), and +5.71 D (regimen III).
Conclusions:
- Tropicamide 0.5% and phenylephrine 0.5% is a viable alternative to tropicamide 1.0% and cyclopentolate 1.0% in older children.
- This regimen offers a way to achieve effective cycloplegia while potentially avoiding cyclopentolate-associated adverse effects.
Background:
The ideal cycloplegic drug that is safe, effective and convenient in children is not yet available. This study aimed to evaluate the safety and efficacy of three cycloplegic regimens in hyperopic children with pigmented irides. The responses to cycloplegia in different age groups and presence of strabismus were also compared.
Methods:
Tropicamide 0.5% and phenylephrine 0.5% (regimen I), tropicamide 1.0% and cyclopentolate 1.0% (regimen II), and atropine 1.0% (regimen III) were evaluated in 25 children using a crossover study design. Cycloplegic refractions were assessed.
Results:
The mean age of the children was 5.7 +/- 2.0 years (range 2.5-10.8 years). Six (24.0%) of them had strabismus. The spherical equivalent (SE) refraction for regimens I, II and III were +5.11 +/- 2.04 D, +5.29 +/- 1.89 D and +5.71 +/- 1.90 D, respectively, and were significant different from the manifest SE (+3.95 +/- 2.17 D) (P < 0.001). There was no statistical difference between regimen I and II in children without strabismus (P = 0.258) or aged older than 5 years (P > 0.050).
Conclusion:
In older children, regimen I was as effective as regimen II and can be used to avoid cyclopentolate toxicity.
