O uso do colírio de atropina como estratégia terapêutica para retardar o desenvolvimento de miopia em crianças

Abstract

Introduction: Myopia is the main refractive disorder and the main cause of visual loss worldwide. It is estimated that by 2050 half of the world's population will be nearsighted, doubling the current figures for the condition. 1 To fight against the progression of this epidemic, the topical application of different doses of atropine has been discussed. 6,7,8,9 Objective: To highlight in the literature the efficacy of using atropine eye drops to delay myopia in children, considering the differences in dosages. Methods. A systematic literature review was carried out in the Pub-Med and Lilacs databases with the keywords "myopia AND atropine AND children AND treatment". The search resulted in 103 publications in total. From these, literature reviews, meta-analyzes, observational studies, articles on the etiology of the disease were excluded, according to the title. Studies with a randomized clinical trial were included. In addition, articles with up to 5 years of publication were accepted, resulting in 4 studies used. Discussion: The use of atropine eye drops is advantageous because it is a non-invasive, painless and low-cost treatment.6 The use of atropine in different concentrations was tested in the three experimental trials included in the present study. In them, the respective concentrations of the substance in the eye drops were used, being: 0.5%, 0.1%, 0.01% in the study by Chia et al (2016), 0.05%, 0.025% and 0.01% in the study by Yam et al (2019), 0.01% in the study by Diaz-Llopis et al (2018) and 0.5% in the study by Polling et al (2016). The first clinical trial demonstrated that the mean progression of myopia was -1.38 + 0.98 D to 0.01%, being less than 0.1 and 0.5% of atropine. In the data obtained by Yam et al (2019), the concentration of 0.05% was considered the best for reducing the spherical equivalent (SE). The data obtained by Yam (2019) concluded that the best cost-benefit ratio is also in the concentration of 0.05%, still proposing the use of lower concentrations more times a day. Diaz-Llopis (2018) proved that the 0.01% dilution reduced the progression of myopia to -0.14 + 0.35 D compared to the control, which was -0.65 + 0.54 D. Finally, Polling et al (2016) demonstrated that the use of 0.5% atropine for 1 year reduced the progression to -0.1D / year in relation to the group that abandoned treatment, which was -0.5D / year. Conclusion: The usage of low dose atropine seems to be efficient in slowing the progression of myopia in children. However, the studies, although scientifically relevant and with significant samples, have some limitations because they are unable to cover different populations. Therefore, more research is needed to access results of this substance in other groups.