#31
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Öèòàòà:
Öèòàòà:
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#32
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Tropicamide (1%): an effective cycloplegic agent for myopic children.
Manny RE, Hussein M, Scheiman M, Kurtz D, Niemann K, Zinzer K; COMET Study Group. College of Optometry, University of Houston, 505 J. Davis Armistead Bldg., Houston, TX 77204-2020, USA. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] PURPOSE. To evaluate the cycloplegic effect of 1% tropicamide in myopic children and to determine whether its efficacy is associated with age, gender, iris color, ethnicity, magnitude of the refractive error, or latent error. METHODS. Four hundred sixty-nine children enrolled in the Correction of Myopia Evaluation Trial (COMET; a multicenter, randomized, double-masked clinical trial evaluating the rate of progression of juvenile-onset myopia in children wearing progressive-addition versus single-vision lenses) were given 1 drop of proparacaine in each eye followed 1 minute later by 1 drop of 1% tropicamide and then a second drop of 1% tropicamide 4 to 6 minutes later. Five accommodative responses to 20/100 letters located at 4 m and 33 cm were obtained in each eye with an autorefractor, 20 minutes after the second drop. Residual accommodation was calculated as the difference between the mean spherical equivalent responses obtained at the two distances. An examiner graded iris color, and ethnicity was reported by the children's parents or guardians. RESULTS. The mean residual accommodation was small: 0.38 +/- 0.41 diopters (D) in the right eye and 0.30 +/- 0.41 D in the left eye. Small but statistically significant differences in residual accommodation were associated with ethnicity, but not with any of the other factors. CONCLUSIONS. Tropicamide (1%) is an effective cycloplegic agent in myopic children. |
#33
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Comparison of tropicamide and cyclopentolate for cycloplegic refractions in myopic adult refractive surgery patients.
Author(s): Hofmeister EM, Kaupp SE, Schallhorn SC Affiliation(s): Navy Refractive Surgery Center, Department of Ophthalmology, Naval Medical Center, San Diego, California 92134-1005, USA. Publication date & source: 2005-04, J Cataract Refract Surg., 31(4):694-700. Publication type: Clinical Trial; Randomized Controlled Trial PURPOSE: To compare tropicamide 1%, a shorter-acting cycloplegic agent, with cyclopentolate 1% for cycloplegic refractions in adult refractive surgery patients. SETTING: Navy Refractive Surgery Center, Ophthalmology, Naval Medical Center, San Diego, California. METHODS: The study was prospective, single center, with randomized sequencing of cycloplegic agent; each patient received both agents. Thirty consecutive myopic adult refractive surgery patients (mean age 35.4 years) participated. A complete preoperative examination, including cycloplegic refraction, was obtained twice, 1 week apart. The patient and the examiner were masked to the medication. Main outcome measures included cycloplegic and manifest refractions, best corrected distance acuity, near-point accommodation, pupil diameters, and subjective appraisal of experience with cycloplegic agents. RESULTS: Twenty-eight of 30 patients completed both examinations. Both eyes were measured, but comparisons were limited to right and left eyes, independently. No statistically significant difference was found between the tropicamide and cyclopentolate cycloplegic refractions (mean difference in MSE +/- SD, OD=0.054 +/- 0.214 diopters (D), t=1.33, P=.10; OS=0.054 +/- 0.253 D, t=1.12, P=.14). Five eyes of 3 patients had a difference of 0.50 D or greater between the 2 agents; less myopia with cyclopentolate. Near-point testing revealed less residual accommodation with cyclopentolate (difference in MSE, OD=-0.27 +/- 0.51 D, t=2.68, P=.006; OS=-0.32 +/- 0.49 D, t=3.46, P=.001). Subjectively, 24 of 28 (86%) patients preferred tropicamide, 1 (4%) preferred cyclopentolate, and 3 (10%) had no preference. CONCLUSIONS: There was no statistically significant difference in mean cycloplegic refractions. Cyclopentolate was more effective than tropicamide in reducing accommodative amplitude in adult myopes (near-point testing). Patients strongly preferred tropicamide. |
#34
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Äóìàþ, ïîðà ñâîðà÷èâàòü ïîëåìèêó. È íå òîëüêî ïîòîìó, ÷òî ïðåäñòàâëåííûå àðãóìåíòû çàâåäîìî íåêîððåêòíû, èáî îá àòðîïèíå è ðå÷è íåò. Çàìå÷ó, ÷òî â ïðåäñòàâëåííûõ âûæèìêàõ èç ñòàòåé èìåþòñÿ íàñòîðàæèâàþùèå ìàðêåðû.
1-å ñîîáùåíèå. The mean residual accommodation was small: 0.38 +/- 0.41 diopters (D) in the right eye and 0.30 +/- 0.41 D in the left eye. CONCLUSIONS. Tropicamide (1%) is an effective cycloplegic agent in myopic children. Òî åñòü, â îòäåëüíûõ ñëó÷àÿõ îñòàòî÷íàÿ àêêîìîäàöèÿ ñîñòàâëÿëà 0,71 è 0,79 äïòð ñîîòâåòñòâåííî, åñëè íå áîëåå. Ïðåäñòàâëåí âåäü ñðåäíèé ðàçáðîñ. Õîðîø öèêëîïëåãèê! 2-å ñîîáùåíèå. Patients strongly preferred tropicamide. Äàííàÿ ôðàçà ìíå ñëèøêîì õîðîøî çíàêîìà ïî (íàó÷íî) ðåêëàìíîìó ñîïðîâîæäåíèþ ÌÊË, ðàñòâîðîâ äëÿ õðàíåíèÿ è ìí. äð. È îáùèé ìàðêåð: íè ñëîâà î ñëó÷àÿõ óñèëåíèÿ ðåôðàêöèè ïîñëå èíñòèëëÿöèé òðîïèêàìèäà. Âèäèìî, ó ðîññèÿí ãëàçà äðóãèå, èëè íàøè äîêòîðà è ïðîôåññîðà ÷åãî-òî ïîíàïðèäóìûâàëè. Ìîæåò, ÿ è îøèáàþñü. Òðóäíîñòè ïåðåâîäà, çíàåòå ëè. Ñåãîäíÿ â ñåòè íàòêíóëñÿ íà ðåôåðàò ñòàòüè èòàëüÿíñêèõ àâòîðîâ (Myopia evolution in pre-school children …), ãäå ñêàçàíî, ÷òî ìèîïèÿ óìåíüøèëàñü ïîñëå íàçíà÷åíèÿ ïîëíîé êîððåêöèè è â áîëüøåé ñòåïåíè ó äåâî÷åê, íåæåëè ó ìàëü÷èêîâ. Ïî÷åìó îíè äî ñèõ ïîð íå ïîëó÷èëè Íîáåëåâñêóþ? Çà êà÷åñòâåííóþ öèêëîïëåãèþ â òîì ÷èñëå. Ïðè âñåõ ðàñõîæäåíèÿõ âî âçãëÿäàõ è ïðî÷èõ íþàíñàõ, çàðóáåæíûå êîëëåãè íå èñêëþ÷àþò àòðîïèí èç ñâîåé ïðàêòèêè, à èñïîëüçóþò åãî öåëåíàïðàâëåííî. Íàïðèìåð, ó äåòåé ñ òåìíîé ðàäóæêîé, ïðè ñî÷åòàíèè äàëüíîçîðêîñòè ñî ñõîäÿùèìñÿ êîñîãëàçèåì è ò.ï. Î ëå÷åáíîì ïðèìåíåíèè àòðîïèíà ÿ äàæå íå óïîìèíàþ. Ó íàñ æå …  ëþáîì ñëó÷àå, áëàãîäàðþ çà ïîëåçíûé ðàçãîâîð. Ìíîãîå äëÿ ñåáÿ ïðîÿñíèë. |
#36
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Öèòàòà:
Öèòàòà:
 99% ñëó÷àåâ ó ìèîïîâ ðåôðàêöèÿ ïî Sph óìåíüøàåòñÿ îò 0 äî 1 äèîïòðèè ïî ïîêàçàòåëÿì ðåôðàêòîìåòðà, ÷àñòî ñ ïåðåðàñïðåäåëåíèåì ìåæäó îñÿìè â ïîëüçó óâåëè÷åíèÿ àñòèãìàòèçìà. Íî èññëåäóÿ ðåôðàêöèþ ñóáúåêòèâíî, îáû÷íî óìåíüøàåòñÿ âñåãî îò 0 äî 0,25 äèîïòðèé. Ïðîôåñîð Â.È. Ïîñïåëîâ óæå äàâíî ðàòóåò çà ïîëíóþ êîððåêöèþ è ñ÷èòàåò, ÷òî îíà ñïîñîáñòâóåò âîññòàíîâëåíèþ îáúåìîâ àêêîìîäàöèè. - À Âû eyemate çà ïîëíóþ êîððåêöèþ? - Åñëè íà øèðîêèé çðà÷îê âèçóñ 1.0, à íà óçêèé 0.8 - ýòî ïîëíàÿ êîððåêöèÿ? |
#37
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Öèòàòà:
Öèòàòà:
Êîððèãèðóåì ìû ðåôðàêöèîííûå àíîìàëèè, à íå àêêîìîäàöèííûå íàñëîåíèÿ (òàì ñâîè ïîäõîäû). Äîëæíû, ïî êðàéíåé ìåðå. Åñòü, êîíå÷íî, èñêëþ÷åíèÿ, íî ñåé÷àñ ðå÷ü î ñóòè, î ôóíäàìåíòå. ×òîáû ïåðåøàãíóòü ÷åðåç ìíåíèå êëàññèêîâ, íóæíû î÷åíü âåñêèå îñíîâàíèÿ. Ïðîôåññîð Â. È. Ïîñïåëîâ ðàòóåò çà ïîëíóþ êîððåêöèþ ìèîïèè, íî íà äðóãîé äèàãíîñòè÷åñêîé è ëå÷åáíîé îñíîâå. Ïîçèöèÿ ìîÿ èçëàãàëàñü ðàíåå. ß çà ïîëíóþ êîððåêöèþ, íî ïðè îïðåäåëåííûõ óñëîâèÿõ è ïðè îïðåäåëåííîé åå òðàêòîâêå.  íåîáõîäèìûõ ñëó÷àÿõ äîïóñêàþ è ïåðåêîððåêöèþ. ß çà ðàçíûå âèäû öèêëîïëåãèè ïî ïîêàçàíèÿì, è ïðîòèâ íàçíà÷åíèÿ öèêëîïëåãèè âñåì ïîäðÿä. Âàøà æå ïîçèöèÿ îäíîáîêà: òîëüêî ìÿãêàÿ (÷àñòî íåêà÷åñòâåííàÿ) öèêëîïëåãèÿ è ïîëíàÿ êîððåêöèÿ ïî åå ðåçóëüòàòàì. Îíà, êñòàòè, íå òàê óæ ïëîõà. Èáî ãîðàçäî ÷àùå äàæå ïðè íàëè÷èè ïîêàçàíèé öèêëîïëåãèÿ íå ïðèìåíÿåòñÿ âîîáùå (æåëàíèå ïðèíÿòü è çàðàáîòàòü ïîáîëüøå, íåäîñòàòîê âðà÷åé, íåñîãëàñèå ïàöèåíòà). È áðàêà ïðè íåé ïîìåíüøå, íî ïî ìîåé îöåíêå âñå æå ìíîãîâàòî. Ïî÷åìó íèêòî èç âàñ, óâàæàåìûå ìîè îïïîíåíòû, íå îòâå÷àåò íà äâàæäû ïîñòàâëåííûé ïðÿìîé âîïðîñ îá óñèëåíèè ðåôðàêöèè ïîñëå çàêàïûâàíèÿ öèêëîìåäà èëè ìèäðóìà? ×òî äóìàåòå Âû ëè÷íî â ýòèõ ÷àñòûõ ñëó÷àÿõ î êà÷åñòâå ïîëó÷åííîãî Âàìè "àêêîìîäàöèîííîãî ïàðàëè÷à"? Ìîæåòå íå îòâå÷àòü. Ïðîñòî çàäóìàéòåñü. |
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#38
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eyemate äàéòå ññûëêè íà èññëåäîâàíèÿ òîãî , ÷òî òðîïèêàìèä íå ïîäõîäèò äëÿ îïðåäåëåíèÿ ðåôðàêöèè ïðè ìèîïèè. Ìíåíèÿ àâòîðèòåòîâ âàæíî , íî âñå æå ôîðóì ïî äîêàçàòåëüíîé ìåäèöèíå. ß çíàþ àâòîðèòåòîâ êîòîðûå è àìáëèîêîð íàçíà÷àþò è ËÎÒ ñ ðó÷åéêîì.
Åùå õîòåëîñü áû ññûëîê èññëåäîâàíèÿ ïî óñèëåíèè ðåôðàêöèè íà öèêëîìåäå. |
#39
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Ïîæàëóéñòà. Âîò, ÷òî áûëî ïîä ðóêîé. Ôàìèëèè â îôòàëüìîëîãèè âåñüìà óâàæàåìûå è àâòîðèòåòíûå.
1. Êóçíåöîâà Ì. Â. Ïðè÷èíû ðàçâèòèÿ áëèçîðóêîñòè è åå ëå÷åíèå. – Ì.: Ìåäýêñïðåññèíôîðì, 2004. – Ñ. 168. 2. Îíóôðèé÷óê Î.Í., Ðîçåíáëþì Þ.Ç. Çàêîíîìåðíîñòè ðåôðàêòîãåíåçà è êðèòåðèé ïðîãíîçèðîâàíèÿ øêîëüíîé ìèîïèè // Âåñò. îôò. – 2007. - ¹1. – Ñ. 22-24. 3. Ïðîñêóðèíà Î. Â. Òîíóñ àêêîìîäàöèè ó äåòåé // Ðåôðàêöèîííàÿ õèðóðãèÿ è îôòàëüìîëîãèÿ. – 2004. – ò. 4. – Ñ.16-19. 4. Ïðîñêóðèíà Î. Â. Äèíàìèêà ðåôðàêöèè, äèàãíîñòèêà è ïðèíöèïû î÷êîâîé êîððåêöèè àìåòðîïèè ó äåòåé è ïîäðîñòêîâ. Àâòîðåô. äèññ. äîêò. ìåä. íàóê. – Ì., 2007. - Ñ. – 50. Ì. Â. Êóçíåöîâà ñîîáùàåò îá óñèëåíèè ðåôðàêöèè íà 0,5 äïòð â óñëîâèÿõ «ìÿãêîé» öèêëîïëåãèè ó 18% îáñëåäîâàííûõ äåòåé-ìèîïîâ. Àíàëîãè÷íàÿ èíôîðìàöèÿ îá óñèëåíèè ïðèâû÷íîãî òîíóñà àêêîìîäàöèè âî âðåìÿ öèêëîïëåãèè èìååòñÿ â ìàòåðèàëàõ Î. Â. Ïðîñêóðèíîé, Î. Í. Îíîôðèé÷óêà è Þ. Ç. Ðîçåíáëþìà. Ê ñîæàëåíèþ, ìàòåðèàëàìè î ïîäõîäàõ Â. È. Ïîñïåëîâà ê öèêëîïëåãèè íå ðàñïîëàãàþ. Íî èõ ìîæíî íàéòè â ñåòè. ß â íåêîòîðîé ðàñòåðÿííîñòè, èáî ìîè íàáëþäåíèÿ îá óñèëåíèè àêêîìîäàöèîííîãî òîíóñà âî âðåìÿ ìÿãêîé öèêëîïëåãèè ñîâïàäàþò ñ íàáëþäåíèÿìè ðîññèéñêèõ äîêòîðîâ è ïðîôåññîðîâ. À ó ìîèõ îïïîíåíòîâ èç ÐÌÑ ïî÷åìó-òî íåò. Èíòåðåñíî â ÷åì ïðè÷èíà? Íà ýòîì îáùåíèå ïî äàííîé òåìàòèêå ïðåêðàùàþ. Âûâîäû ïóñòü êàæäûé ñäåëàåò ñàì. À òî, ïîìíþ, ñïàçì áûë ëåò 20, ïîòîì âäðóã ïðîïàë. È âñå òóò. Íàäåþñü, ÷òî çàñòàâèë êîãî-òî êîëëåã ïðèçàäóìàòüñÿ. Åñëè ýòî òàê, öåëü îáùåíèÿ äîñòèãíóòà. Óäà÷è. |
#40
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Óâàæàåìûé eyemate.
Íåìíîãî OFF - Íàïèøèòå ïîæàëóéñòà â ïîäïèñè èìÿ è îò÷åñòâî. Íå î÷åíü óäîáíî îáðàùàòüñÿ ê Âàì ïî íèêó. Äåëî â òîì, ÷òî íà ýòîì ôîðóìå ñëîæèëàñü òàêàÿ òðàäèöèÿ , ÷òî ìû çäåñü ïûòàåìñÿ îáùàòüñÿ íà ÿçûêå äîêàçàòåëüíîé ìåäèöèíû. Ò.å ïðåäëàãàòü òå âåùè , ýôôåêòèâíîñòü êîòîðûõ äîêàçàíà. Êîãäà ìû ãîâîðèì îá "àâòîðèòåòàõ", åñëè íå òðåáîâàòü äîêàçàòåëüñòâ , à ïðîñòî äàâèòü ñèëîé àâòîðèòåòà , òî òîãäà ìû óêàçûâàåì íà èñòî÷íèêè (íàïðèìåð æóðíàëû) ñ âûñîêèì óðîâíåì öèòèðóåìîñòè.  Ðîññèè òàêèõ æóðíàëîâ íå âûïóñêàåòñÿ. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïî÷åìó-òî ïðÿìàÿ ññûëêà îòîáðàæàåòñÿ ó ìåíÿ êðèâî. Òîãäà âîò òàê:[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] òàì êëèêíèòå åùå ðàç Çäåñü, áîëåå õîðîøî îáúÿñíåííî , òî ÷òî ÿ èìåþ ââèäó. Ìåæäóíàðîäíûé ÿçûê ìåäèöèíû àíãëèéñêèé è ìíå ñòðàííî , ÷òî Âû ïðèâåëè òîëüêî ðóññêèå èñòî÷íèêè. ß ïîãóãëèë Âàøè ññûëêè è íàòêíóëñÿ òàê æå íà ÄÝÍÀÑ - òåðàïèþ , ðåôëåêñîòåðàïèþ è öâåòîèìïóëüñíóþ òåðàïèþ... Ñïàñèáî Âàì! |
#41
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The cycloplegic effects of cyclopentolate and tropicamide on myopic children.
Lin LL, Shih YF, Hsiao CH, Su TC, Chen CJ, Hung PT. Department of Ophthalmology, National Taiwan University, Taipei, Republic of China. Thirty-seven myopic children were given either 1-2 drops of 1% cyclopentolate or 1% tropicamide twice with 5 min intervals to evaluate the time course and maximal cycloplegic effect of both agents. The other fifteen subjects were given 1% tropicamide initially, then 1% cyclopentolate given after 30 min of maximal effect of tropicamide appeared to evaluate whether the effect of cyclopentolate was superior to tropicamide. Cycloplegic refraction was measured with an auto-refractometer (Topcon RK-3000) before drug delivery and every 15 min thereafter, for 90 min. The maximal cycloplegic effect of cyclopentolate was around 45 min, then it remained stable until 90 min after the last instillation. The effect of tropicamide was faster than that of cyclopentolate. It was around 30 min, then it stabilized until 75 min. The extra effect of cyclopentolate over tropicamide was minimal (only -0.1D). The power of cornea and astigmatism were not affected by either agent. However, a big variation in astigmatism was noted during the course, especially with cyclopentolate. This study suggests that 1% tropicamide should be a good agent for routine refractive status checking on myopic children. |
#42
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Ïðèâåäó ïîêà òîëüêî ñàéò, ãäå ìíîãî ñòàòåé Â.È. Ïîñïåëîâà: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (ñì. âíèçó ñòàòüè, ìåòîäè÷åñêèå ìàòåðèàëû).
Ê ïîñòó #41: ïî÷åìó íà öèêëîìåäå èäåò áîëüøîé ðàçáðîñ ïî àñòèãìàòèçìó? Íåêîðåêòíî ñðàâíèâàòü ñèëó öèêëîìåäà ñ òðîïèêàìèäîì - ïîñëå çàêàïûâàíèå òðîïèêàìèäà. Êîððåêòíî ïî ìåòîäîëîãèè ñðàâíèòü äî öèêëîïëåãèè è ïîñëå, íî â êàæäîé ãðóïïå îòäåëüíî. |
#43
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Ïîæàëóéñòà, àíãëîÿçû÷íûé èñòî÷íèê.
Hopkins G., Pearson R. Ophtalmic drugs: diagnostic and therapeutic uses (2007). Èñïîëüçîâàíû äàííûå îäíîé èç òàáëèö, òðàêòîâêà ìîÿ. Àòðîïèíîâàÿ öèêëîïëåãèÿ íàñòóïàåò â ñðåäíåì ÷åðåç 36 ÷àñîâ, íî ýòî öèêëîïëåãèÿ, èáî îñòàòî÷íàÿ àêêîìîäàöèÿ ñîñòàâëÿåò 0,0 äïòð. Ïðè èíñòèëëÿöèÿõ öèêëîïåíòîëàòà öèêëîïàðåç íàñòóïàåò ïðèìåðíî ÷åðåç 60 ìèíóò, à òðîïèêàìèäà - ÷åðåç 30 ìèíóò, ïîñêîëüêó îñòàòî÷íàÿ àêêîìîäàöèÿ â ïåðâîì ñëó÷àå â ñðåäíåì ñîñòàâëÿåò 1,0 äïòð, âî âòîðîì - 2,0 äïòð. Âèäèìî, â ýòîì ñèñòåìíàÿ îñíîâà íàøèõ ðàñõîæäåíèé. Ñïàñèáî. |
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Öèòàòà:
Íî ðàçâå ýòî íå ãîâîðèò î òîì ÷òî â äàííîè ñëó÷àå áëèçîðóêîñòü âûçâàíà ñïàçìîì àêêîìîäàöèè à íå óäëèííåíèåì ãëàçíîãî ÿáëîêà??  òàêèõ ñëó÷àÿõ ñîâåòóþò êàê ìîæíî áûñòðåå ñíÿòü ñïàçì àêêîìîäàöèîííîé ìûøöû ïîêà ãëàç íå íà÷àë èçìåíÿòü ñâîþ ôîðìó. Îáúÿñíèòå ïîæàëóéñòà åñëè ÿ ÷òî-òî íåäîïîíèìàþ |
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Alexdub
Ïðÿìî â äåñÿòêó. Íî ïðîñòî òîëüêî íà ïåðâûé âçãëÿä. |