目的：分析中央孔型有晶状体眼人工晶状体(ICL V4c)植入术后房角结构变化及其与术前眼前段解剖参数的相关性。

方法：回顾性病例研究。收集2024年7月至2024年11月于哈尔滨医科大学附属第二医院眼科屈光中心行ICL V4c植入术的近视或者近视合并散光的患者。记录手术前后裸眼视力、最佳矫正视力、眼压、前房角(ACA)、白到白距离(WTW)、前房深度(ACD)、角到角距离(ATA)、水平沟到沟距离(HSTS)、垂直沟到沟距离(VSTS)、晶状体上升高度(CLR)、瞳孔直径(PD)、距离巩膜突750 μm处虹膜厚度(IT750)、最大虹膜厚度(ITM)、虹膜曲率(I-Curv)、虹膜横截面积(I-Area)、颞、鼻、上、下四方位的房角开放距离(AOD750)、小梁虹膜夹角(TIA750)和小梁虹膜面积(TISA750)以及术后各时间点拱高。

结果：本研究共纳入接受ICL V4c植入术的近视或近视合并散光患者40例79眼，其中男10例，女30例，平均年龄为24.73±3.79岁。与术前相比，术后1 mo AOD750、TIA750、TISA750在颞、鼻、上、下四个方位的房角参数均出现显著减小(P<0.01)。术后1 d拱高为0.49±0.1、术后1 wk为0.43±0.14、术后1 mo为0.41±0.14 mm(P<0.001)。相关性分析表明，术后房角状态受到前房空间(ACD，ATA，HSTS，VSTS)、虹膜形态(I-Area，IT750)、瞳孔大小(PD)及手术因素(ICL尺寸、早期拱高)的共同影响，且不同方位的影响因素组合存在差异。回归分析显示：ACD与术后各房角参数呈正相关(P<0.05)； IT750与颞、下方房角呈负相关(P<0.05)； I-Area与颞侧AOD750、TISA750均呈正相关(均P<0.05)； PD与颞侧TIA750、鼻侧AOD750均呈负相关(均P<0.05)。

结论：ICL V4c植入术后房角普遍变窄，其变化与多项术前眼前段解剖参数呈显著相关。术前综合评估ACD、PD及IT750可能有助于评估术后房角变化风险并提高手术安全性。

METHODS: Retrospective case study. Patients with myopia or myopia combined with astigmatism who underwent ICL V4c implantation in the Refractive Surgery Center of the Department of Ophthalmology, the 2^nd Affiliated Hospital of Harbin Medical University between July 2024 and November 2024 were recruited. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity, intraocular pressure, anterior chamber angle(ACA), white-to-white distance(WTW), anterior chamber depth(ACD), angle to angle distance(ATA), horizontal sulcus-to-sulcus distance(HSTS), vertical sulcus-to-sulcus distance(VSTS),crystalline lens rise(CLR), pupil diameter(PD), iris thickness at 750 μm from the scleral spur(IT750),maximal iris thickness(ITM), iris curvature(I-Curv), and iris cross-sectional area(I-Area), angle opening distance(AOD750), thetrabecular-iris angle(TIA750)and the trabecular-iris space area(TISA750)in the temporal, nasal, superior, and inferior directions,as well as the vault at various postoperative time points were measured.

RESULTS: The study involved 40 patients(79 eyes)with myopia or myopia combined with astigmatism who underwent ICL V4c implantation(10 males and 30 females)with the mean age of 24.73±3.79 y. Compared with preoperative measurements, at 1 mo postoperatively, the AOD750, TIA750, and TISA750 parameters at the four angles(temporal, nasal, superior, and inferior)all showed a significant reduction(P<0.01). Statistically significant differences in vault were observed at postoperative 1d(0.49±0.1), postoperative 1 wk(0.43±0.14), and postoperative 1 mo(0.41±0.14)(all P<0.001). Correlation analysis indicated that the postoperative state of the anterior chamber angle was jointly influenced by anterior chamber parameters(ACD, ATA, HSTS、VSTS), iris morphology(I-Area, IT750), pupil size(PD), and surgical factors(ICL size, early vault), and that the combination of influencing factors varied across different orientations. Regression analysis showed that ACD was positively correlated with all postoperative anterior chamber angle parameters(P<0.05). IT750 exhibited negative correlations with the temporal and inferior angles(P<0.05). I-Area was positively correlated with temporal AOD750 and TISA750(P<0.05), and PD had negative correlations with temporal TIA750 and nasal AOD750(P<0.05).

CONCLUSION: Postoperative anterior chamber angle narrowing is a common phenomenon after ICL V4c implantation. The degree of change exhibits a significant correlation with multiple preoperative anterior segment anatomical parameters. Preoperative comprehensive assessment of ACD, PD, and IT750 may facilitate the evaluation of the risk of postoperative angle changes and the enhancement of surgical safety.