The aim of this study was to explore the application and the correlation of atropine eye gel and compound topicamide eye drops in cycloplegic refraction for children.

151 cases (302 eyes) who were admitted to Eye Center of Beijing Tongren Hospital affiliated with Capital Medical University from January 2016 to March 2019 were collected. They were aged 3 to 10 years-old with an average age of (6.0±1.5) years-old, including 68 males (136 eyes) and 83 females (166 eyes). Patients were divided into hyperopia group, myopia group and mixed astigmatism group according to their refractive status. All patients underwent cycloplegic refraction using compound topicamide and atropine, resepctviely. The cycloplegic refraction results of two drugs for children in each group, including diopter of spherical power (DS), diopter of cylindrical power (DC), axial length (AL) and corrected visual acuity (CVA) were analyzed. All indices were not in accordance with the normal distribution by Kolmogorov-Smirnov normal test, which was described by median and quartile. And the rank sum test within group paired samples was performed.

There were 63 cases (126 eyes), 41 cases (82 eyes), 47 cases (94 eyes) in patients of hyperopia, mixed astigmatism group and myopia group, respectively. There was no statistical difference among three groups in gender (χ²=0.171, P>0.05), and age (F=1.399, P>0.05). In hyperopia group, DS, DC, AL and CVA of compound topicamide after cycloplegic refraction were 2.50 (1.00, 5.31) D, 1.00 (0.50, 1.75) D, 90 (85, 100) and 0.10 (0.00, 0.20); the results of atropine′s were 3.50 (2.00, 6.31) D, 1.00 (0.50, 1.75) D, 90 (85, 95), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS, DC and CVA (Z=9.692, -2.726, -2.483; P<0.05); but non-significant differences in AL (Z=-0.173, P>0.05). In mixed astigmatism group, the results of compound topicamide after cycloplegic refraction were -1.00 (-2.00, -0.75) D, 3.00 (2.00, 4.00) D, 90 (85, 95), 0.10 (0.00, 0.20); the results of atropine′s were -0.50 (-1.25, 0.00) D, 3.00 (2.00, 4.00) D, 90 (85, 95), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS and CVA (Z=7.778, -2.826; P<0.05); but non-significant differences in DC, AL (Z=-1.098, -0.653; P>0.05). In myopia group, the results of compound topicamide after cycloplegic refraction were -3.05 (0-6.00, -1.25) D, -1.38 (-2.50, -0.50) D, 90 (85, 95), 0.00 (0.00, 0.20); the results of atropine′s were -3.13 (-5.25, -1.00), -1.50 (-2.50, -0.50), 90.00 (85.00, 95.00), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS and CVA (Z=8.388, -2.744; P<0.05); but non-significant differences in DC and AL (Z=0.511, -1.735; P>0.05). The corresponding functional relationship of 3 groups were y_atropine=1.068+ 0.976x_topicamide, y_atropine=0.775+ 0.999x_topicamide, y_atropine=0.248+ 0.949x_topicamide, respectively. In three groups, the D value of DS for patients younger than 6 years-old and aged 6 years-old or older was 1.00 (0.75, 1.44) D, 0.75 (0.50, 1.00) D, 1.00 (0.50, 1.25) D, 0.50(0.25, 0.75) D, 0.50(0.25, 0.75) D, 0.25 (0.00, 0.50) D, respectively. After the rank sum test of independent samples, there were significant difference within groups (Z=-2.261, -4.160, -2.360; P<0.05).

After using two drugs in each refractive state group, there were greater difference in cycloplegic refraction for younger patients. Atropine was suggested to use for children with hyperopia and mixed astigmatism to perform the cycloplegic refraction. In special cases, mixed astigmatism and myopia children aged 6 years or younger could be modified to the topicamide mydriatic′s result by using the correlation function relationship as atropine′s. For children with myopia over 6 years-old, the compound tropine was suggested to use.