Atropin zur Prävention der Myopieprogression – Datenlage, Nebenwirkungen, praktische Empfehlungen

Zusammenfassung

Die Prävalenz der Myopie hat in den letzten Jahrzehnten weltweit zugenommen. In den südostasiatischen Metropolen werden Raten von ≥ 80% bei jungen Erwachsenen erreicht. Diese teilweise dramatische Zunahme ist vor allem den veränderten Lebensgewohnheiten geschuldet. Seit mehr als 100 Jahren weiß man um die hemmende Wirkung des Atropins auf die Myopieprogression. Obgleich der genaue Wirkungsmechanismus noch unbekannt ist, wurde in der letzten Dekade doch eine evidenzbasierte Behandlungsstrategie entwickelt. Atropintropfen können die Myopieprogression bei asiatischen Kindern im Mittel um − 0,54 Dioptrien (dpt)/Jahr und bei kaukasischen Kindern um − 0,35 dpt/Jahr mildern. Zu beachten ist jedoch eine Nichtansprechrate von ca. 10%. Die Behandlung sollte nur bei Schulkindern (Alter ≥ 6 Jahre) mit einer nachgewiesenen Progressionsrate von − 0,5 dpt im Vorjahr begonnen werden. Die zykloplegisch ermittelte Ausgangsrefraktion sollte zumindest − 2 dpt (sphärisches Äquivalent) betragen. Empfohlen wird die Applikation 0,01%iger Tropfen 1× am Abend vor dem Schlafengehen in den Bindehautsack. Die Therapie mit 0,01% gilt als gut verträglich und nebenwirkungsarm. Die Behandlung wird zunächst über 2 Jahre durchgeführt, da zum Teil im 2. Jahr eine bessere Effektivität erzielt wurde. Ein halbjährliches Kontrollintervall während der Behandlung mit jeweiliger Bestimmung der Refraktion in Zykloplegie und Messung der Achsenlänge wird empfohlen. Anschließend kann ein Auslassversuch erfolgen, wenn die Progression unter − 0,25 dpt/Jahr im 2. Jahr gefallen ist. Auch nach Therapieende sind weitere Kontrollen angezeigt, wobei eine erneute Behandlung bei einem neuerlichen Ansteigen der Progression über − 0,5 dpt/Jahr anzuraten ist. Ferner ist zu beachten, dass die Behandlung mit Atropinaugentropfen eine Off-Label-Anwendung darstellt.

Abstract

The prevalence of myopia has increased worldwide in recent decades. In East Asiaʼs metropolises ≥ 80% of young adults are affected. This dramatic increase is mainly caused by changes in lifestyle and behaviour. Atropine has been used for more than 100 years to arrest myopia progression. It has become an evidence-based treatment regimen in the last decade, although the exact mechanism of the effect of treatment is still unknown. Atropine eye drops can slow myopia progression by an average of − 0.54 dioptres (D)/year in Asian children and − 0.35 D/year in Caucasian children. However, a non-response rate of about 10% has been found. Treatment should be established in schoolchildren only (age ≥ 6 years) with myopia ≤ − 2 D (spherical equivalent, cycoplegic refraction) and with documented myopic progression of − 0.5 D in the preceding year. 0.01% eyedrops should be instilled into the lower fornix at bedtime. Atropine 0.01% therapy is well tolerated. Atropine is usually administered for 2 years since efficacy is somewhat better in the second year. During treatment, a 6-month follow-up with cycoplegic refraction and axial length measurement is recommended. After the 2-year period, atropine withdrawal is justified if progression is less than − 0.25 D/year in the second year. Even after atropine has been stopped, follow-up examinations are needed to detect any rebound. Atropine-therapy is resumed if progression is again higher than − 0.5 D/year. Topical atropine is used off-label.

Schlüsselwörter

Myopie - Progression - Atropin - Augentropfen

Key words

myopia - progression - atropine - eyedrops

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