Effect of 4-Month Intermittent Atropine Penalization in Amblyopic Children for Whom Patch Therapy Had Failed.

PURPOSE To evaluate the effect of 4-month intermittent atropine penalization in children with amblyopia for whom patch therapy had failed and to analyze the factors associated with treatment success. METHODS This retrospective observational study included participants who visited the hospital between January 1, 2011, and December 31, 2015. Forty-one children with amblyopia for whom patch therapy had failed were included and their medical records were analyzed retrospectively. They were treated with 1% atropine eye drops in the sound eye twice per week for 4 months. Treatment success was defined as a best corrected visual acuity (BCVA) improvement of two lines in the amblyopic eye. Age, cause of amblyopia, pretreatment BCVA at the start of atropine penalization in the amblyopic eye, age at the start of eyeglass prescription, age at the start of patch therapy, duration, compliance with and total amount of patch therapy, type of refraction, type of strabismus, and cause of failure of patch therapy were analyzed and compared between two groups: the failure and success groups. RESULTS Twenty of 41 patients (48.8%) showed treatment success. The mean age was 5.59 ± 1.52 years and the mean BCVA of the amblyopic eye was 0.40 ± 0.20 logarithm of the minimum angle of resolution (logMAR). Younger age and poor pretreatment BCVA at the start of atropine penalization in the amblyopic eye were the factors associated with treatment success. CONCLUSIONS Intermittent atropine penalization for 4 months can improve BCVA in children with amblyopia for whom patch therapy has failed. Atropine penalization can be especially effective in younger children and those with poor BCVA at the start of atropine penalization in the amblyopic eye. [J Pediatr Ophthalmol Strabismus. 2017;54(6):375-380.].