Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes

Sun Ho Park; Sae Mi Park; A Ran Cho; Song Hee Park

doi:10.3341/jkos.2014.55.4.590

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Park, Park, Cho, and Park: Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes

Original Article

J Korean Ophthalmol Soc 2014;55(4):590-595.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.4.590

Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes

Sun Ho Park, MD¹, Sae Mi Park, MD², A Ran Cho, MD³, Song Hee Park, MD, PhD¹

¹Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

²Pureun Eye Clinic, Gwangju, Korea

³Seoul St. Mary’s Eye Hospital, Suwon, Korea

Address reprint requests to Song Hee Park, MD, PhD Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea, Tel: 82-2-709-9356, Fax: 82-2-798-7797 E-mail: scheye@hosp.sch.ac.kr

Received 2 August 201327 September 2013 Accepted 20 February 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 of 40 children with amblyopia before and after receiving atropine sulfate 1% solution. Amblyopic children were divided into 2 groups according 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 the scheduled follow-up visits.

Results

Visual acuity of the sound eye at distance showed greater decreases in children with 4-day follow-up visits compared with 7-day visits in the amblyopic group (p = 0.24). There was no significant difference in near visual acuity between the amblyopic group and the normal control group by follow-up interval (p = 0.98, p = 0.75). Near point of accommodation significantly increased in the 4-day visit group in both the amblyopic and the normal control groups (p = 0.04 and p = 0.03, respectively), Pupil size 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 pharmacologic effect, two separate atropine instillations per week (on a weekday and the weekend) should be considered as a treatment for amblyopia.

Keywords: Amblyopia, Atropine penalization treatment, Weekend atropine

References

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Figure 1.

A 6-years-old female child, after 7 days atropine instillation on right sound eye. Compared with left amblyopic eye (B), pupil of right sound eye (A) did not nearly dilate and showed an intact light reflex on light condition.

Figure 2.

Change of visual acuity in amblyopic and normal children at distance (A), at near (B). Group 1 = 4-days fol-low-up, amblyopic children; Group 2 = 7-days follow-up, amblyopic children; Group 3 = 4-days follow-up, normal children; Group 4 = 7-days follow-up, normal children.

Figure 3.

Change of NPA (A) and pupil size (B) in amblyopic and normal children. NPA = near point of accommodation; Group 1 = 4-days follow-up, amblyopic children; Group 2 = 7-days follow-up, amblyopic children; Group 3 = 4-days fol-low-up, normal children; Group 4 = 7-days follow-up, normal children. ^* Statistically significant difference between two groups.

Table 1.

Baseline characteristics of the amblyopic and normal subjects

Variables (years)	Amblyopia		Normal		p-value^*
Variables (years)	4-days F/U (Group 1)	7-days F/U (Group 2)	4-days F/U (Group 3)	7-days F/U (Group 4)	p-value^*
Subjects (eyes)	20	20	10	10
Sex (male/female)	12/8	10/10	5/5	5/5	0.88^*
Age (years)	6.60 ± 2.14	6.40 ± 2.35	6.90 ± 2.28	5.00 ± 2.30	0.14^*
Initial distance VA (log MAR)	0.08 ± 0.19	0.06 ± 0.08	0.03 ± 0.05	0.12 ± 0.31	0.36^†
Initial near VA (log MAR)	0.10 ± 0.19	0.06 ± 0.12	0.00 ± 0.00	0.10 ± 0.22	0.41^†
Initial NPA (cm)	6.58 ± 1.72	6.00 ± 1.56	6.75 ± 1.51	6.35 ± 1.58	0.59^†

Values are presented as mean ± SD. VA = visual acuity; NPA = near point of accommodation.

^* ANOVA

^† Kruskal-Wallis test.

Table 2.

Change of visual acuity and NPA, pupil size in amblyopic and normal children after Atropine instillation

Variables	Amblyopia		p-value	Normal		p-value
Variables	4-days F/U (Group 1)	7-days F/U (Group 2)	p-value	4-days F/U (Group 3)	7-days F/U (Group 4)	p-value
Initial distance VA (log MAR)	0.08 ± 0.19	0.06 ± 0.08	0.38^†	0.03 ± 0.05	0.12 ± 0.31	0.09^†
Initial near VA (log MAR)	0.10 ± 0.19	0.06 ± 0.12	0.70^†	0.00 ± 0.00	0.10 ± 0.22	0.28^†
Initial NPA (cm)	6.58 ± 1.72	6.00 ± 1.56	0.81^*	6.75 ± 1.51	6.35 ± 1.58	0.94^*
Post 1 hour distance VA (log MAR)	0.23 ± 0.17	0.22 ± 0.17	0.95^†	0.15 ± 0.11	0.16 ± 0.20	0.19^†
Post 1 hour near VA (log MAR)	0.53 ± 0.28	0.58 ± 0.40	0.80^†	0.70 ± 0.33	0.48 ± 0.44	0.32^†
Post 1 hour NPA (cm)	6.63 ± 1.92	6.30 ± 1.81	0.86^*	7.65 ± 1.70	6.35 ± 1.62	0.81^*
Post 1 hour pupil size (mm)	7.43 ± 0.57	7.50 ± 0.67	0.36^*	7.40 ± 0.46	7.60 ± 0.88	0.12^*
Follow-up distance VA (log MAR)	0.21 ± 0.21	0.12 ± 0.13	0.24^†	0.05 ± 0.08	0.18 ± 0.18	0.10^†
Follow-up near VA (log MAR)	0.33 ± 0.32	0.31 ± 0.32	0.98^†	0.14 ± 0.08	0.17 ± 0.29	0.75^†
Follow-up NPA (cm)	8.50 ± 2.76	7.95 ± 1.78	0.04^*	9.30 ± 3.95	7.95 ± 2.36	0.03^*
Follow-up pupil size (mm)	7.33 ± 0.54	6.35 ± 1.08	0.01^*	6.50 ± 0.97	6.85 ± 0.91	0.55^*

Values are presented as mean ± SD.

NPA = near point of accommodation; VA = visual acuity.

^* t-test

^† Mann-Whitney U- test.

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