目的：分析人工晶状体(IOL)置换术的原因及临床效果。

方法：回顾性病例系列研究。收集 2020年4月至2024年5月在郑州大学第一附属医院眼科接受IOL置换术患者47例53眼，年龄5-87(平均44.8±3.6)岁。记录患者基本信息、手术原因、手术方式、手术前后的裸眼视力(UCVA)与最佳矫正视力(BCVA)以及术后并发症。

结果：纳入47例53眼IOL置换术患者手术原因：屈光不正18例23眼(43%)，IOL移位12例13眼(25%)，IOL变性12例12眼(23%)，多焦点IOL植入术后神经适应不良3例3眼(6%)，患者视觉质量不满意2例2眼(4%)。IOL置换手术方式包括IOL囊袋内固定16眼(30%)，睫状沟固定27眼(51%)，巩膜缝线固定10眼(19%)。术前和术后1 d UCVA(LogMAR)比较有差异(1.03±0.64 vs 0.50±0.46，P<0.05)。术前和术后1 mo BCVA(LogMAR)比较有差异(0.41±0.37 vs 0.17±0.21，P<0.05)。术后并发症包括晶状体后囊膜混浊2眼，IOL移位1眼。

结论：屈光不正、IOL移位和IOL变性是IOL置换的主要原因。多焦点IOL术后神经适应不良及患者视觉质量不满意等新兴因素占比虽低，但反映了患者对视觉质量要求的提升。IOL置换术具有一定的挑战性，但临床效果良好，并发症较少，是处理白内障术后IOL异常的有效方法。

METHODS:This retrospective case series study included 47 patients(53 eyes)who underwent IOL exchange surgery at the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, between April 2020 and May 2024, aged from 5 to 87(44.8±3.6)years old. Patients' demographics, surgical indications, surgical techniques, preoperative and postoperative uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA), as well as postoperative complications were recorded.

RESULTS:The reasons for IOL exchange included refractive error(18 cases, 23 eyes, 43%), IOL dislocation(12 cases, 13 eyes, 25%), IOL opacification(12 cases, 12 eyes, 23%), neuroadaptation failure(3 cases, 3 eyes, 6%), and patient dissatisfaction with visual quality(2 cases, 2 eyes, 4%). The surgical techniques for IOL exchange included in-the-bag IOL fixation(16 eyes, 30%), ciliary sulcus fixation(27 eyes, 51%), and scleral suture fixation(10 eyes, 19%). There was statistical significant difference between preoperative UCVA(LogMAR)and UCVA(LogMAR)at 1 d postoperatively(1.03±0.64 vs 0.50±0.46, P<0.05), and there was statistical significant difference between preoperative BCVA(LogMAR)and BCVA(LogMAR)at 1 mo postoperatively(0.41±0.37 vs 0.17±0.21, P<0.05). Postoperative complications included posterior capsule opacification in 2 eyes and IOL dislocation in 1 eye.

CONCLUSION:Refractive error, IOL dislocation, and IOL opacification were the three most common reasons for IOL exchange. Although less frequent, factors such as neuroadaptation issues associated with multifocal IOLs and patient-reported visual quality dissatisfaction reflect growing expectations for improved visual outcomes. IOL exchange surgery, though technically challenging, demonstrates favorable clinical efficacy and a low complication rate, representing an effective intervention for managing postoperative IOL-related issues following cataract surgery.