低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识（2022）

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摘要当前全球近视患病率呈快速增长趋势，预计至2050年全球将有47.58亿近视人口，占总人口的49.8%[1]。中华人民共和国国家卫生健康委员会公布，2020年中国儿童青少年近视患病率为52.7%，其中小学生为35.6%，初中生为71.1%，高中生为80.5%[2]。由于近视呈现低龄化、高度化和患病率持续升高趋势，病理性近视患病率也显著增高。病理性近视可因脉络膜新生血管，视网膜变性、裂孔和脱离等眼底改变，造成不可逆的视觉损害，严重者可致盲，给个人、家庭和社会带来沉重负担。因此，预防近视发生、延缓近视进展、防止病理性近视发生刻不容缓。阿托品药物在近视防控中的应用由来已久，近年来低浓度阿托品滴眼液的应用逐渐受到关注。尽管目前关于低浓度阿托品滴眼液的近视防控应用在中国未获得国家药监部门正式批准应用于临床，但在部分省份已经以院内制剂方式经省级药监部门批准在院内有条件的情况下使用，同时部分患儿亦可凭医师开具的处方通过互联网医院获得，但关于阿托品滴眼液的浓度选择，其有效性、安全性以及使用规范，国内尚无统一的指导性意见。从临床用药规范以及近视防控重要意义的双重角度考虑，有必要形成低浓度阿托品滴眼液的临床使用专家共识，以期为广大一线眼科工作者提供指导，推动我国近视防控工作的健康发展。本专家共识由中华医学会眼科学分会眼视光学组、中国医师协会眼科分会眼视光专业委员会的组长和执笔团队在文献查阅、临床实践性研究的基础上酝酿而成，并由2个学组牵头组织近百名专家经过文献研究、初稿开放讨论、多轮修改和循证、审稿及定稿等程序，形成最终版本共识。 1? 阿托品的有效性 2? 机制 3? 安全性及不良反应处理 3.1 安全性和不良反应 3.1.1 瞳孔散大、畏光反应和眼压升高 3.1.2 调节能力和近视力下降 3.1.3 过敏反应 3.1.4 刺激性反应 3.2 不良反应的处理 4? 适应证和禁忌证 4.1 适应证 4.1.1 年龄 4.1.2 近视屈光度和增长量 4.1.3 依从性 4.2 禁忌证 5? 使用规范 5.1 基线评估 5.1.1 临床检查 5.1.2 近视快速进展危险因素评估 5.2 用药前宣教 5.3 用药过程和随访 5.4 停药 5.4.1 常规停药 5.4.1.1 停药时机选择 5.4.1.2 反弹效应 5.4.1.3 停药后重新再用药 5.4.2 异常停药 5.4.2.1 用药防控近视效果不佳 5.4.2.2 不良反应 6? 注意事项

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关键词 ：低浓度阿托品滴眼液, 近视防控, 有效性, 安全性, 使用规范

Abstract：

Key words： low-concentration atropine eye drops prevention and control of myopia efficiency safety specification

收稿日期: 2022-06-08

PACS:

基金资助:

通讯作者: 瞿佳（ORCID：0000-0003-1678-966X），Email：jia.qu@eye.ac.cn

引用本文:

中华医学会眼科学分会眼视光学组，中国医师协会眼科医师分会眼视光专业委员会. 低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识（2022）[J]. 中华眼视光学与视觉科学杂志, 2022, 24(6): 401-409. Chinese Ophthalmological Society, Optometry Committee of Chinese Ophthalmologists Association. Expert Consensus on Application of Low-Concentration Atropine Eye Drops in the Prevention and Control of Myopia in Children and Adolescents (2022). Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(6): 401-409.

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https://www.cjoovs.com/CN/ 或 https://www.cjoovs.com/CN/Y2022/V24/I6/401

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