Comparison of Different Cycloplegic Refraction Regimens for Children

Irawati Irfani, Fany Gunawan, Karmelita Satari, Maya Sari, Primawita Oktarima, Sesy Caesarya, Feti Karfiati

Abstract


In the process of a pediatric eye exam, cycloplegic refraction is a crucial step. Since no single cycloplegic drug is ideal, a combination regimen is employed. This study compares the ocular (refractive power and pupil diameter) and systemic (blood pressure and heart rate) effects of administering a combination of 1% cyclopentolate and 2.5% phenylephrine, with or without 1% tropicamide, to children with refractive errors. This study aimed to discover a more feasible regimen for children. This was a single-blind study, a randomized clinical trial conducted from November–December 2020 in children with mild to moderate refractive errors. Group A received 1% cyclopentolate, 2.5% phenylephrine, and 1% tropicamide (SFT), whereas group B received 1% cyclopentolate and 2.5% phenylephrine (SF). The outcomes were measured using an auto refractometer and IOL Master® 700. Before and 60 minutes after medication was administered, blood pressure and heart rate were measured. There were 54 participants (108 eyes) with an average age of 12.85± 2.84 years. Although the SFT group's refractive power and pupil width were greater than those of the SF group, the differences were not statistically significant (p=0.271 and p=0.088). Heart rate (p=0.521) and blood pressure (systolic p=0.201; diastolic p=0.950) did not significantly differ between the two groups. Despite mydriasis manifested more rapidly in the SFT group, there was no discernible difference in the cycloplegic effects between those groups. SF might be a more feasible regimen for cycloplegic refraction in children with refractive errors.

Keywords


Cyclopentolate, cycloplegic, mydriasis, phenylephrine, tropicamide

Full Text:

PDF

References


  1. Dhanesha U, Polack S, Bastawrous A, Banks LM. Prevalence and causes of visual impairment among schoolchildren in Mekelle, Ethiopia. Cogent Med. 2018;5:1554832.
  2. Harrington SC, Stack J, Saunders K, O’Dwyer V. Refractive error and visual impairment in Ireland schoolchildren. Br J Ophthalmol. 2019;103(8):1112–8. doi:10.1136/bjophthalmol-2018-312573
  3. WHO. World Report on Vision. Geneva: World Health Organization; 2019.
  4. Halim A, Suganda R, Sirait NS, Memed FK, Syumarti, Rini M, et al. Prevalence and associated factors of uncorrected refractive errors among school children in suburban areas in Bandung, Indonesia. Cogent Med. 2020;7(1):1737354.
  5. Sherman AE, Shaw MM, Ralay-Ranaivo H, Rahmani B. Tropicamide has limited clinical effect on cycloplegia and mydriasis when combined with cyclopentolate and phenylephrine. J AAPOS. 2019:2.e1-30.e5.
  6. Laojaroenwanit S, Layanun V, Praneeprachachon P, Pukrushpan P. Time of maximum cycloplegia after instillation of cyclopentolate 1% in children with brown irises. Clin Ophthalmol. 2016;10:897–902.
  7. Kyei S, Nketsiah AA, Asiedu K, Awuah A, Owusu-Ansah A. Onset and duration of cycloplegic action of 1% cyclopentolate – 1% tropicamide combination. Afr Health Sci. 2017;17(3):923–32. doi:10.4314/ahs.v17i3.36
  8. Yazdani N, Sadeghi R, Momeni-Moghaddam H, Zarifmahmoudi L, Ehsaei A. Comparison of cyclopentolate versus tropicamide cycloplegia: A systematic review and meta-analysis. J Optom. 2018;11:135–43.
  9. Yoo SG, Cho MJ, Kim US, Baek S-H. Cycloplegic refraction in hyperopic children: Effectiveness of a 0.5% tropicamide and 0.5% phenylephrine addition to 1% cyclopentolate regimen. Korean J Ophthalmol. 2017;31(3):249.
  10. American Academy of Ophthalmology. Pediatric Eye Evaluations Preferred Practice Pattern®. San Francisco; Elsevier Inc.; 2017.
  11. Minderhout HM, Joosse M V, Grootendorst DC, Schalij-Delfos NE. A randomized clinical trial using atropine, cyclopentolate, and tropicamide to compare refractive outcome in hypermetropic children with a dark iris; skin pigmentation and crying as significant factors for hypermetropic outcome. Strabismus. 2019;27(3):127–38. doi:10.1080/09273972.2019.1629466
  12. Liewellyn S, Khandelwal P, Glaze S, Thomas P, Dahlmann-Noor A. Time to drop the phenylephrine from the paediatric cycloplegia protocol: informing practice through audit. Eye. 2019;33:337–8. doi:10.1038/s41433-018-0246-5
  13. Gupta SK. Mydriatics and cycloplegics. In: Gupta SK, Agarwal R, Srivastava S, eds. Textbook on Clinical Ocular Pharmacology and Therapeutics. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2014.p. 87–95.
  14. Esteve-Taboada JJ, Del Aguila-Carrasco AJ, Bernal-Molina P, Ferrer-Blasco T, Lopez-Gil N, Montes-Mico R. Effect of phenylephrine on the accommodative system. J Ophthalmol. 2016;2016:1–13. doi:10.1155/2016/7968918




DOI: https://doi.org/10.15395/mkb.v56.3311

Article Metrics

Abstract view : 88 times
PDF - 41 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats