약시안에서 아트로핀 처벌치료의 약리 효과
Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes
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목적: 약시안에서 아트로핀 처벌치료의 약리 효과를 분석하고, 이에 영향을 주는 인자들을 알아보고자 하였다. 대상과 방법: 약시 환아 40명을 대상으로 아트로핀 점안 전, 후의 원거리 및 근거리시력, 조절근점, 동공 크기를 측정하였으며, 약시가없는 정상 환아 20명을 대조군으로 하였다. 동일 검사를 4일 경과 관찰군(20명)과 7일 경과 관찰군(20명)으로 나누어 시행하여 아트로핀의 약리 효과를 분석하고자 하였고, 치료 효과가 떨어지는 환자에서 원인 및 해결방법에 대해 알아보고자 하였다. 결과: 아트로핀 점안 후 원거리 시력은 약시 환아군에서 4일 경과관찰군이 7일 경과관찰군에 비해 시력 감소 효과를 컸지만 통계적으로 유의한 차이는 없었고(p=0.24), 근거리 시력은 약시 환아군과 정상대조군에서 모두 경과관찰 기간에 따른 유의한 차이는 없었다(p=0.98,p=0.75). 조절근점은 약시환아군과 정상대조군에서 모두 4일 경과관찰군이 통계적으로 유의하게 증가하였으며(p=0.04, p=0.03), 동공크기는 약시 환아군에서 4일 경과관찰군이 7일 경과관찰군에 비해 통계적으로 유의하게 크게 유지되는 결과를 보였다(p=0.01). 결론: 약시안에서 주 1회의 아트로핀 점안은 약시 치료를 위해 유의한 약리 효과를 나타내나, 효과를 안전하게 유지하기 위해서는주중과 주말로 간격을 두어 주 2회 점안하는 것을 고려해 볼 수 있겠다.
Abstract
Purpose: To analyze the pharmacologic effect of atropine penalization in amblyopic eyes. Methods: Distant and near visual acuity, near point of accommodation (NPA), and pupil size were measured in the sound eye of40 children with amblyopia before and after receiving atropine sulfate 1% solution. Amblyopic children were divided into 2 groupsaccording to the time of follow-up visit: 4-days and 7-days after injection; the same tests were performed on all the scheduled follow-up visits. This study included a control group of 20 normal children who received the same test on the initial visit and thescheduled follow-up visits. Results: Visual acuity of the sound eye at distance showed greater decreases in children with 4-day follow-up visits comparedwith 7-day visits in the amblyopic group (p = 0.24). There was no significant difference in near visual acuity between the amblyopicgroup and the normal control group by follow-up interval (p = 0.98, p = 0.75). Near point of accommodation significantlyincreased in the 4-day visit group in both the amblyopic and the normal control groups (p = 0.04 and p = 0.03, respectively), Pupilsize was significantly maintained in the 4-day visit, amblyopic group (p = 0.01). Conclusions: Atropine effectively decreased the vision of the sound eye in amblyopic children. However, to maintain the pharmacologiceffect, two separate atropine instillations per week (on a weekday and the weekend) should be considered as a treatmentfor amblyopia.
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