PDF(Pubmed)
Abstract：
Purpose: To comprehensively assess rebound effects by comparing myopia progression during atropine treatment and after discontinuation. Methods: A systematic search of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov was conducted up to 20 September 2023, using the keywords \"myopia,\" \"rebound,\" and \"discontinue.\" Language restrictions were not applied, and reference lists were scrutinized for relevant studies. Our study selection criteria focused on randomized control trials and interventional studies involving children with myopia, specifically those treated with atropine or combination therapies for a minimum of 6 months, followed by a cessation period of at least 1 month. The analysis centered on reporting annual rates of myopia progression, considering changes in spherical equivalent (SE) or axial length (AL). Data extraction was performed by three independent reviewers, and heterogeneity was assessed using I2 statistics. A random-effects model was applied, and effect sizes were determined through weighted mean differences with 95% confidence intervals Our primary outcome was the evaluation of rebound effects on spherical equivalent or axial length. Subgroup analyses were conducted based on cessation and treatment durations, dosage levels, age, and baseline SE to provide a nuanced understanding of the data. Results: The analysis included 13 studies involving 2060 children. Rebound effects on SE were significantly higher at 6 months (WMD, 0.926 D/y; 95%CI, 0.288-1.563 D/y; p = .004) compared to 12 months (WMD, 0.268 D/y; 95%CI, 0.077-0.460 D/y; p = .006) after discontinuation of atropine. AL showed similar trends, with higher rebound effects at 6 months (WMD, 0.328 mm/y; 95%CI, 0.165-0.492 mm/y; p < .001) compared to 12 months (WMD, 0.121 mm/y; 95%CI, 0.02-0.217 mm/y; p = .014). Sensitivity analyses confirmed consistent results. Shorter treatment durations, younger age, and higher baseline SE levels were associated with more pronounced rebound effects. Transitioning or stepwise cessation still caused rebound effects but combining optical therapy with atropine seemed to prevent the rebound effects. Conclusion: Our meta-analysis highlights the temporal and dose-dependent rebound effects after discontinuing atropine. Individuals with shorter treatment durations, younger age, and higher baseline SE tend to experience more significant rebound effects. Further research on the rebound effect is warranted. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463093], identifier [registration number].
摘要：
目的：通过比较阿托品治疗期间和停药后的近视进展，全面评估反弹效应。方法：系统搜索PubMed，EMBASE,科克伦中部,和ClinicalTrials.gov进行到2023年9月20日，使用关键词“近视，\"\"反弹，\"和\"停止。\"未应用语言限制，和参考清单被仔细审查相关研究。我们的研究选择标准集中于涉及近视儿童的随机对照试验和介入研究。特别是那些用阿托品或联合疗法治疗至少6个月，随后是至少1个月的停止期。分析集中在报告每年的近视进展率，考虑球面当量（SE）或轴向长度（AL）的变化。数据提取由三名独立评审员进行，异质性使用I2统计量进行评估。应用了随机效应模型，和效应大小是通过95%置信区间的加权平均差异确定的。我们的主要结果是对球形等效或轴向长度的反弹效应的评估。根据停药和治疗持续时间进行亚组分析，剂量水平，年龄,和基线SE，以提供对数据的细致入微的理解。结果：分析包括13项研究，涉及2060名儿童。对SE的反弹效应在6个月时显著更高(WMD，0.926D/y；95CI，0.288-1.563D/y；p=.004）与12个月相比（大规模杀伤性武器，0.268D/y；95CI，0.077-0.460D/y；p=.006）停用阿托品后。AL表现出类似的趋势，在6个月时具有更高的反弹效应(大规模杀伤性武器，0.328毫米/年；95CI，0.165-0.492毫米/年；p<.001)与12个月(大规模杀伤性武器，0.121毫米/年；95CI，0.02-0.217毫米/年；p=0.014）。敏感性分析证实了一致的结果。更短的治疗持续时间，年龄较小,较高的基线SE水平与更明显的反弹效应相关。过渡或逐步停止仍然会引起反弹效应，但将光学疗法与阿托品相结合似乎可以防止反弹效应。结论：我们的荟萃分析强调了停用阿托品后的时间和剂量依赖性反弹效应。治疗持续时间较短的个体，年龄较小,较高的基线SE往往会经历更显著的反弹效应。有必要对回弹效应进行进一步研究。系统审查注册：[https://www。crd.约克。AC.uk/prospro/display_record.php?RecordID=463093],标识符[注册号]。
