RESUMO
Objective To examine the published evidence on the effectiveness of topical atropine for the prevention childhood myopia progression and the myopic rebound occurring after cessation of atropine.Methods A meta analysis,with a focus on randomized controlled trials (RCTs),was conducted by using the following electronic databases:PubMed,EMBASE,and Cohrane Library.The search strategy were ‘ myopia’ OR ‘ refractive error’ OR ‘ nearsighted’ AND ‘ atropine’ OR ‘ anti-muscarinic’ AND ‘ child’ OR ‘ children’ OR ‘ kids’ OR ‘ adolescent’.The last search was run on April 9,2019 and Jadad scoring system was used to evaluate the quality of each RCT.Results Eleven RCTs with 3 162 children aged 5-15 years and spherical equivalent ranging-0.50 to-6.75 D were included.Most of the studies found a beneficial effect in myopic control when treated with atropine compared with various control groups.The mean difference (MD) between the treatment and control groups in myopic progression were 0.95 D/year (95％ confidence interval [CI]:0.69-1.22),0.93 D/year (95％ CI:0.50-1.36),0.82 D/year (95％ CI:0.68-0.96),0.46 D/year (95％ CI:-0.02-0.94) for 1.0％,0.5％,0.1％ and 0.01％ topical atropine,respectively (P＜0.001).After 12 months of atropine cessation,the analysis indicated that the MD between the different dosage of atropine,used during the treatment period,and the control group was-0.36 D/year (95％ CI:-0.70--0.02,P=0.04,I2:98％).Conclusions Atropine is a potent option in myopic control.Even though,a myopic rebound was reported after treatment cessation,atropine-treated eyes have a slower myopia progression compare to controls.Low dosages of atropine (especially 0.01％) seem to have minimal rebound effect and few side effects.