目的：比较基于不同类型角膜屈光力的人工晶状体(IOL)计算公式在角膜屈光术后白内障患者中计算IOL屈光度的准确性。

方法：前瞻性临床研究。收集2022年2月至2024年8月就诊于济南明水眼科医院，既往有近视激光角膜手术史的白内障手术患者32例42眼。使用基于模拟角膜曲率(SimK)的Haigis-L公式、Barrett True K公式，基于全角膜曲率(TK)的Haigis公式、基于角膜净屈光力(TNP)的Potvin-Hill Pentacam(PVP)公式及基于净角膜屈光力(NCP)的OCT公式计算IOL度数及预测屈光度数。术后1 mo进行主觉验光，计算预测误差(PE)及其绝对值、绝对预测误差均值(MAE)、绝对预测误差中位数(MedAE)及PE在±0.25、±0.50、±0.75、±1.0 D范围内的百分比。

结果：4种类型角膜屈光力组内相关系数为0.986(P<0.001)，TNP与NCP比较无差异(P=0.491)，其余两两比较有差异(均P<0.001)。Haigis-L(K)、Haigis(TK)的PE与0比较有差异(均P<0.001)，PVP、OCT、Barrett True K公式的PE与0比较无差异(均P>0.05)。5种公式中Barrett True K的MedAE值最小0.32(0.19，0.71)D，5种公式的MedAE总体比较无差异(P=0.870)。Barrett True K公式的PE在±0.25、±1.0 D内的眼占比分别为38%(16/42)、95%(40/42)； PVP公式的PE在±0.50 D内的眼占比为71%(30/42)； Haigis(TK)公式的PE在±0.75 D内的眼占比为83%(35/42)。

结论：角膜屈光术后，不同类型角膜屈光力间存在差异。进行IOL计算时，TK联合Haigis公式的准确性优于Haigis-L(K)公式，Barrett True K公式表现出良好的准确性。

METHODS: A prospective clinical study was conducted with a cohort of 32 cataract patients(42 eyes)who had previously undergone myopic laser corneal surgery at Jinan Mingshui Eye Hospital between February 2022 and August 2024. The study employed several IOL calculation formulas, including the Haigis-L formula, the Barrett True K formula based on simulated keratometry(SimK), the Haigis formula based on total keratometry(TK), the Potvin-Hill Pentacam(PVP)formula based on corneal true net power(TNP), and the OCT formula based on net corneal power(NCP). These formulas were used to calculate IOL power and predict postoperative refractive outcomes. At 1 mo postoperatively, subjective refraction was performed, and the prediction error(PE), mean absolute prediction error(MAE), median absolute prediction error(MedAE), and the percentage of prediction errors within the ranges of ±0.25, ±0.50, ±0.75, and ±1.0 D were determined.

RESULTS: The intraclass correlation coefficient for the four types of corneal refractive power was 0.986(P<0.001). There was no significant difference between TNP and NCP(P=0.491), and there were differences between the other two groups(all P<0.001). Statistically significant differences were observed between PE and 0 for the Haigis-L(K)and Haigis(TK)formulas(all P<0.001). In contrast, no statistically significant differences were noted between PE and 0 for the PVP, OCT, and Barrett True K formulas(all P>0.05). The MedAE value of Barrett True K was the smallest 0.32(0.19, 0.71)D among the five formulas, and there was no significant difference in MedAE among the five formulas(P=0.870). The proportion of eyes with PE within ±0.25 and ±1.0 D in Barrett True K formula was 38%(16/42)and 95%(40/42), respectively. The proportion of eyes within ±0.50 D in PVP formula was 71%(30/42); and the proportion of eyes with PE within ±0.75 D in Haigis(TK)formula was 83%(35/42).

CONCLUSION: After corneal refractive surgery, there are differences between different types of corneal refractive power. When calculating IOL, the accuracy of TK combined with Haigis formula is better than that of Haigis-L(K)formula, and Barrett True K formula shows good accuracy.