目的：分析影响有晶状体眼后房型人工晶状体(ICL)植入术后总角膜术源性散光的因素。

方法：前瞻性研究。连续纳入2023年7月至2024年1月于我院行ICL植入术的患者162例162眼。依据术前评估的预期术后残留散光情况选择不同切口，75眼预期残留顺归散光的患者选择上方切口，87眼预期残留逆规散光的患者选择颞侧切口。通过眼前节全景分析仪(Pentacam)测量患者术前及术后3 mo全角膜屈光力、手术切口长度、内口与视轴长度、中央角膜厚度、术前总角膜散光、角膜直径，术后总角膜术源性散光基于手术前后全角膜屈光力变化进行计算，多元线性回归分析以上指标对术后总角膜术源性散光的影响。

结果：本研究共纳入ICL植入术的患者162例162眼，术后失访8例，失访率为4.9%。实际完成研究者为154例154眼，上方切口组72例72眼中男17例，女55例，平均年龄25.96±6.17岁； 颞侧切口组82例82眼中男20例，女62例，平均年龄27.79±6.47岁。两组术后总角膜术源性散光比较无差异\〖0.31(0.21，0.49)D vs 0.27(0.13，0.485)D， P=0.159\〗。多元线性回归分析显示内口与视轴长度、术前总角膜散光对上方切口组总角膜术源性散光有显著影响(P=0.001)，回归方程为：术后总角膜术源性散光=0.71-0.381×内口与视轴长度+0.16×术前总角膜散光； 而未观察到影响颞侧切口组术后总角膜术源性散光的因素。

结论：ICL植入术中上方切口与颞侧切口术后总角膜术源性散光量值相当。对于上方切口患者可基于内口与视轴长度和术前总角膜散光值预判术后总角膜术源性散光，优化术后视觉质量。

METHODS:This prospective study enrolled 162 patients(162 eyes)who underwent ICL implantation at our hospital between July 2023 and January 2024. Based on preoperative assessment of anticipated postoperative residual astigmatism, different incisions were selected. Superior incision was selected for patients with expected residual astigmatism with the rule in 75 eyes, and temporal incision was selected for patients with expected residual astigmatism againist the rule in 87 eyes. Parameters including total corneal refractive power, incision length, internal ostium-to-visual axis distance, central corneal thickness, preoperative total corneal astigmatism, and corneal diameter were measured using the Pentacam anterior segment analyzer before and at 3 mo after surgery. Postoperative total corneal SIA was calculated based on the changes in total corneal refractive power. Multiple linear regression analysis was performed to assess the influence of the above parameters on postoperative total corneal SIA.

RESULTS:A total of 162 cases(162 eyes)that implanted with ICL were included in the analysis, and 8 cases were lost to follow-up, with a loss rate of 4.9%. Eventually 154 cases(154 eyes)completed the research. The superior incision group comprised 72 cases(72 eyes), including 17 males and 55 females, with a mean age of 25.96±6.17 years, while the temporal incision group comprised 82 cases(82 eyes), including 20 males and 62 females, with a mean age of 27.79±6.47 years. No significant difference in postoperative total corneal SIA was observed between the two groups \〖0.31(0.21, 0.49)D vs. 0.27(0.13, 0.485)D, P=0.159\〗. Multiple linear regression analysis revealed that internal ostium-to-visual axis distance and preoperative total corneal astigmatism significantly influenced postoperative total corneal SIA in the superior incision group(P=0.001). The regression equation was: postoperative total corneal SIA=0.71-0.381×internal ostium-to-visual axis distance+0.16×preoperative total corneal astigmatism. No significant influencing factors for postoperative total corneal SIA were identified in the temporal incision group.

CONCLUSION: During ICL implantation, the magnitude of total corneal SIA is comparable between superior and temporal incisions. For patients receiving a superior incision, the internal ostium-to-visual axis distance and preoperative total corneal astigmatism value can be used to quantitatively predict postoperative total corneal SIA to a certain extent, thereby aiding in the optimization of postoperative visual quality.