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Background Neostigmine is a widely used muscle relaxant antagonist that requires combination with anticholinergic agents like atropine to mitigate its muscarinic effects. Glycopyrrolate exerts less influence on cardiac conduction than atropine, making it a preferable option. However, clinical research on its pediatric use is limited. This study aims to compare the effects of glycopyrrolate and atropine, in combination with neostigmine, on heart rate and adverse events in pediatric patients. Methods Children undergoing penile flap surgery under general anesthesia combined with a caudal block were randomly assigned to either the glycopyrrolate group (Group G, n  = 100) or the atropine group (Group A, n  = 100). Postoperatively, patients in Group G received glycopyrrolate (8 µg/kg) and neostigmine (40 µg/kg), while those in Group A received atropine (20 µg/kg) and neostigmine (40 µg/kg) to reverse neuromuscular blockade. The baseline heart rate was defined as the heart rate measured before administering the trial drug, with heart rates recorded every minute thereafter, along with any adverse events noted within 24 h post-operation. Results There were no statistically significant differences in age, surgery duration, or baseline heart rates between the two groups ( p  > 0.05). Heart rate changes within 15 min post-administration were less pronounced in the glycopyrrolate group compared to the atropine group ( p  < 0.05), indicating reduced fluctuation from baseline. Additionally, the area under the curve (AUC) for heart rate changes in the first 15 min post-administration was lower in the glycopyrrolate group ( p  < 0.05). No statistically significant differences in adverse events were observed between the two groups ( p  > 0.05). Conclusions Compared to atropine, the combination of glycopyrrolate and neostigmine results in less fluctuation in heart rate but a higher incidence of dry mouth, with no significant differences in other complications. Therefore, glycopyrrolate may be preferred in scenarios where hemodynamic stability is prioritized, considering its higher risk of dry mouth.

Four hundred myopic children randomly received atropine 0.02% (n = 138) or 0.01% (n = 142) in both eyes once-nightly or only wore single-vision spectacles (control group) (n = 120) for 2 years. Spherical equivalent refractive error (SER), axial length (AL), pupil diameter (PD), and amplitude of accommodation (AMP) were measured every 4 months. After 2 years, the SER changes were − 0.80 (0.52) D, − 0.93 (0.59) D and − 1.33 (0.72) D and the AL changes were 0.62 (0.29) mm, 0.72 (0.31) mm and 0.88 (0.35) mm in the 0.02% and 0.01% atropine groups and control group, respectively. There were significant differences between changes in SER and AL in the three groups (all P  < 0.001). The changes in SER and AL in the 2nd year were similar to the changes in the 1st year in the three groups (all P  > 0.05). From baseline to 2 years, the overall decrease in AMP and increase in PD were not significantly different in the two atropine groups, whereas the AMP and PD in the control group remained stable (all P  > 0.05). 0.02% atropine had a better effect on myopia control than 0.01% atropine, and its effects on PD and AMP were similar to 0.01% atropine. 0.02% or 0.01% atropine controlled myopia progression and AL elongation synchronously and had similar effects on myopia control each year.

AimsTo evaluate the efficacy and safety of 0.01% atropine eye-drops in controlling myopia progression over 5 years.MethodsExperimental, analytical, prospective, randomised and longitudinal study, in 361 right eyes from 361 children randomised into the control group (177 eyes without treatment) and treatment group (184 eyes with 0.01% atropine eye-drops). Children assigned to the treatment group used 0.01% atropine once a day every night and the control group’s children did not use any treatment or placebo. All the subjects completed an eye examination every 6 months for the 5 years of follow-up. The examination included subjective and objective refraction with cycloplegia, axial length (AL), keratometry and anterior chamber depth (ACD) to evaluate the efficacy of the treatment. It also included the anterior and posterior pole examination to evaluate the safety of the treatment.ResultsThe SE increased −0.63±0.42D in children after 5 years of treatment with 0.01% atropine, while in the control group the increase was −0.92±0.56D. AL increased 0.26±0.28 mm in the treatment group compared with 0.49±0.34 mm in the control group. Atropine 0.01% showed an efficacy of 31.5% and 46.9% in the control of the SE and AL increase, respectively. ACD and keratometry did not have significant changes between groups.ConclusionsAtropine 0.01% is effective in slowing myopia progression in a European population. There were no side effects after 5 years of 0.01% atropine.

Atropine eye drops and myopic retinal defocus each slow progression of myopia (short-sight). They also cause thickening of the choroid, and it has been suggested that the thickening is a precursor for reduced eye growth and slowed myopia progression. We investigated whether choroidal thickening due to optical defocus would add to thickening due to atropine when both were applied simultaneously. Addition would suggest that combining the two clinical treatments may improve efficacy of myopia control. We studied 20 children receiving 0.3% atropine daily for myopia control, over a period of 6 months. We imposed short periods of retinal defocus (1 h of myopic or hyperopic defocus (± 2.00D)) both before, and after 1 week and 3 and 6 months of atropine treatment. Prior to atropine, myopic or hyperopic defocus caused significantly thicker or thinner choroids respectively (± 12 µm, p < 0.001). After one week of atropine alone, thickness had increased (+ 21 µm; SD 17 µm; p < 0.001), and it increased further (by + 13 µm; SD 6 µm; p < 0.001) when exposed to myopic defocus. Atropine abolished choroidal thinning in response to hyperopic defocus. These effects remained the same after 3 and 6 months of atropine treatment. Our results show that additive effects of atropine and optical defocus are present at the level of the choroid, and suggest that combining optical and pharmaceutical treatments is likely to enhance efficacy of clinical myopia control.

Background/aimsTo report the protocol of a trial designed to evaluate the efficacy, safety and mechanism of action of low-dose atropine (0.01%) eye-drops for reducing progression of myopia in UK children.MethodsMulticentre, double-masked, superiority, placebo-controlled, randomised trial. We will enrol children aged 6–12 years with myopia of −0.50 dioptres or worse in both eyes.We will recruit 289 participants with an allocation ratio of 2:1 (193 atropine; 96 placebo) from five centres. Participants will instil one drop in each eye every day for 2 years and attend a research centre every 6 months. The vehicle and preservative will be the same in both study arms.The primary outcome is SER of both eyes measured by autorefractor under cycloplegia at 2 years (adjusted for baseline). Secondary outcomes include axial length, best corrected distance visual acuity, near visual acuity, reading speed, pupil diameter, accommodation, adverse event rates and allergic reactions, quality of life (EQ-5D-Y) and tolerability at 2 years. Mechanistic evaluations will include: peripheral axial length, peripheral retinal defocus, anterior chamber depth, iris colour, height and weight, activities questionnaire, ciliary body biometry and chorioretinal thickness. Endpoints from both eyes will be pooled in combined analysis using generalised estimating equations to allow for the correlation between eyes within participant. Three years after cessation of treatment, we will also evaluate refractive error and adverse events.ConclusionsThe Childhood Atropine for Myopia Progression in the UK study will be the first randomised trial reporting outcomes of low-dose atropine eye-drops for children with myopia in a UK population.Trial registration number ISRCTN99883695, NCT03690089.

AimTo examine the safety and efficacy of low-dose atropine (0.01% and 0.1% loading dose) after 2-year treatment and 1-year washout in 6-year-old to 12-year-old Danish children with myopia.MethodsInvestigator-initiated, placebo-controlled, double-blind, randomised clinical trial. Of 124 screened children, 97 were randomised to receive 0.01% low-dose atropine for 24 months (0.01%) or 0.1% low-dose atropine for 6 months, then 0.01% for 18 months (0.1% loading dose) or placebo, followed by a 1-year washout. Altogether, 91 participants completed the study. The primary outcome was myopia progression (axial length (AL) and spherical equivalent refraction (SER)). Secondary outcomes were adverse events, ocular biometrical measurements and treatment responder eyes (myopia progression less than −0.50 diopters (D)). Constrained linear mixed models were constructed with individual eyes nested by participant ID, according to intention-to-treat. The responder analysis used Fisher’s exact test. Significance levels were adjusted for multiple comparisons. Adjusted p values <0.05 were considered significant.ResultsAt 3 years, the mean AL was −0.06 mm (95% CI −0.18; 0.07) and −0.09 mm (95% CI −0.21; 0.04) less compared with placebo in the 0.1% loading dose group and 0.01% group. Mean SER was −0.02 D (95% CI −0.30; 0.26) less and 0.17 D (95% CI −0.11; 0.45) more compared with placebo in the 0.1% loading dose group and 0.01% group. There was no significant group difference in the responder eyes.ConclusionThere was no difference in myopia progression between groups following washout. A 6-month 0.1% loading dose did not improve efficacy compared with 0.01%. The 0.1% loading dose showed a rebound effect after dose switching.

We aimed to evaluate the efficacy and safety of low-dose atropine compared to placebo in the Indian population and also to study the impact of various modifiable and non-modifiable factors on myopia progression (MP) and drug efficacy (DE). It was a single-centre prospective placebo-controlled interventional study. 43 participants aged 6–16 years with progressive myopia received 0.01% atropine in the right eyes (treatment) and placebo in the left eyes (control) for 1-year. The main outcome measures were annual MP and axial length elongation (ALE) in treatment and control eyes and their percentage difference between two eyes (drug efficacy). Secondary outcome measures were the occurrence of any adverse events and the correlation of MP, ALE, and DE with various factors. 40 participants (80 eyes) completed the follow-up. After 1-year, MP was 0.25 D (IQR 0.13–0.44) and 0.69 D (IQR 0.50–1.0) (p < 0.001) in treatment and control respectively (63.89% reduction) with respective ALE of 0.14 mm (IQR 0.05–0.35) and 0.32 mm (IQR 0.19–0.46) (p < 0.001) (44.44% reduction). No adverse events were noted. Reduction in MP and ALE was statistically significant in all children irrespective of age-group, baseline MP, family history, screen-time, near and outdoor-time. The strongest determinants of annual MP were age (Treatment: r = − 0.418, p = 0.007; Control: r = − 0.452, p = 0.003) and baseline MP (Treatment: r = 0.64, p = 0.000; Control: r = 0.79, p = 0.000). Screen-time in control eyes was associated with greater ALE (r = 0.620, p = 0.042). DE was higher when outdoor time exceeded 2 h/day (p = 0.035) while the efficacy was lower with prolonged near activities (p = 0.03), baseline fast-progressors (p < 0.05) and history of parental myopia (p < 0.05). 0.01% atropine is effective and safe in retarding MP and ALE in Indian eyes.

To evaluate the concentration-dependent efficacy and safety of sequential orthokeratology (Ortho-K) combined with atropine eye drops (0.01%, 0.025%, 0.05%) for controlling axial elongation in children with progressive myopia, and to characterize clinical outcomes of this stepwise regimen. In this retrospective cohort study, 101 children (199 eyes; age 8–13 years) with axial myopia initially treated with Ortho-K (2020–2024) were analyzed. Participants exhibiting suboptimal responses (axial elongation ≥ 0.15 mm/6 months or ≥ 0.30 mm/12 months) received sequential atropine therapy. Outcomes included axial length changes and adverse event rates across concentration groups. Sequential addition of 0.01%, 0.025%, and 0.05% atropine to Ortho-K reduced annual axial elongation by 28.4%, 31.4%, and 39.4%, respectively ( p  < 0.05 vs. Ortho-K monotherapy). While no severe adverse events occurred, photophobia incidence escalated with higher concentrations (0.05%: 26.3% vs. 0.01%: 8.9%, 0.025%: 11.8%, p  < 0.001). Near-vision blur occurred exclusively in the 0.05% group (15%). Stepwise atropine escalation following Ortho-K demonstrates clinically meaningful, concentration-dependent myopia control with acceptable tolerability. This sequential strategy provides personalized management for children with rapid progression, balancing efficacy and ocular tolerability.

Myopia has been a rising problem globally. Early-onset myopia significantly increases the risk of high myopia later in life. Despite the proven benefits of increased outdoor time, optimal strategies for preventing early-onset myopia in premyopic children need further investigation. This randomized controlled trial aims to evaluate the efficacy of optical (Defocus Incorporated Multiple Segments [DIMS] spectacle lenses) and pharmacological (0.01% atropine eye drops) interventions in preventing myopia among premyopic preschoolers. We will recruit 234 premyopic, asymptomatic 5-to-6-year-old children who will have received cycloplegic autorefraction examination in a countywide kindergarten eye care program in Yilan County, Taiwan. Eligible participants will be randomly assigned to DIMS spectacles (n = 78), 0.01% atropine (n = 78), or usual care (n = 78). In the DIMS group, preschoolers will be instructed to wear spectacles at home before entering elementary school but to wear them all the time after school entry. In the atropine group, subjects will be given 0.01% atropine eyedrops nightly throughout the study period. All participants will be encouraged to spend time outdoors for 2 hours every day. During the 18-month study period, cycloplegic spherical equivalent (SE) refraction, axial length, and subfoveal choroidal thickness will be measured every three months, and parents-administered questionnaires regarding risk factors for myopia will be performed every nine months. The change in mean cycloplegic SE. The cumulative percentage of incident myopia, the cumulative percentage of a fast myopic shift of SE, and the changes in mean axial length. The time to myopia onset, alteration in subfoveal choroidal thickness, and levels of near work/outdoor activities. This study is registered at www.clinicaltrials.gov as NCT06200194. This trial will provide insights into myopia prevention strategies and inform new eye care policies for early identification and intervention in premyopic preschoolers.

To evaluate the efficacy of a myopia control spectacle lens (DIMS) at slowing the progression of myopia in a population of European children in comparison with 0.01% atropine and combined DIMS and atropine. The study was a non-randomised experimenter-masked prospective controlled observational study of individuals aged 6-18 years with progressing myopia but no ocular pathology. Participants were allocated, according to patient/parent choice, to receive 0.01% atropine eyedrops, DIMS (Hoya® MiyoSmart®) spectacles, combined atropine+DIMS or single vision spectacle lenses (control group). The key outcome variables, cycloplegic autorefraction spherical equivalent refraction (SER) and axial length (AL), were measured at baseline and after three, six, and 12 months. Of the 146 participants (mean age 10.3y ±3.2), 53 received atropine, 30 DIMS spectacles, 31 atropine+DIMS, and 32 single vision control spectacles. Generalized linear mixed model analysis revealed for SER, whilst controlling for age and SER at baseline, at each stage all treatment groups had significantly reduced progression compared with the control group (p<0.016). For AL, whilst controlling for baseline age and AL, at 6 and 12 months all treatment groups had significantly less progression than the control group (p<0.005). For SER only, in pairwise comparisons at 12 months the atropine+DIMS group had significantly reduced progression compared with the DIMS only and Atropine only groups (p<0.001). In a European population, DIMS and atropine are effective at reducing myopia progression and axial elongation in progressing myopia and are most successful at reducing myopia progression when used in combination.