Cycloplegic Refraction in Hyperopic Children: Effectiveness of a 0.5% Tropicamide and 0.5% Phenylephrine Addition to
Seul Gi Yoo1, Myung Jin Cho1, Ungsoo Samuel Kim1,2
1Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea.
Insights
Adding Tropherine to cyclopentolate eye drops resulted in a slightly weaker cycloplegic effect, especially in young children with high hyperopia. This Tropherine-added regimen offers a potentially more comfortable option for cycloplegic refraction in children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Optometry
Background:
- Accurate refractive error assessment in children is crucial for timely intervention.
- Cycloplegic eye drops are essential for relaxing accommodation during refraction in pediatric patients.
- Evaluating different cycloplegic regimens can optimize diagnostic accuracy and patient comfort.
Purpose of the Study:
- To compare the efficacy of a combined tropicamide-phenylephrine (Tropherine) and cyclopentolate regimen versus cyclopentolate alone for cycloplegic refraction in hyperopic children.
- To assess the influence of age and degree of hyperopia on the cycloplegic effect of the two regimens.
Main Methods:
- Retrospective review of medical records of 308 hyperopic children under 14 years old.
- Two cycloplegic regimens were used: Regimen 1 (cyclopentolate + Tropherine) and Regimen 2 (cyclopentolate only).
- Comparison of the mean difference between noncycloplegic and cycloplegic spherical equivalent (SE) refractions between the two groups.
Main Results:
- The cyclopentolate-only regimen (Regimen 2) showed a significantly larger mydriatic shift (+1.70 D) compared to the Tropherine-added regimen (Regimen 1, +1.25 D) (p=0.001).
- The difference in SE change was significant only in children aged 5 years or younger, particularly those with high hyperopia (SE ≥5 D) or fully accommodative esotropia.
- No significant differences were observed in children older than 5 years.
Conclusions:
- The Tropherine-added regimen has a weaker cycloplegic effect than cyclopentolate alone, especially in younger children with significant hyperopia or esotropia.
- Despite the difference, the overall refractive change between the regimens was small.
- The Tropherine-added regimen may be a viable and potentially more comfortable alternative for cycloplegic refraction in hyperopic children.
Purpose:
To evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children.
Methods:
The medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens.
Results:
A total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia.
Conclusions:
The Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.
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