[关键词]
[摘要]
现代白内障手术已彻底告别传统复明手术模式，全面迈入以精准屈光矫正为核心的屈光性白内障手术(RCS)新时代，其核心目标是为患者提供全程、清晰、舒适的个性化视觉体验。目前RCS诊疗技术迭代迅速，但围术期全流程精准管控仍存在诸多亟待突破的瓶颈。术前阶段，不同检测原理的眼生物测量设备检测一致性较差，系统测量误差无法完全消除； 人工晶状体(IOL)个体化甄选高度依赖术者临床经验，缺乏标准化量化决策体系，难以实现精准个体化匹配。术中阶段，连续环形撕囊质量受眼部解剖条件、术者操作水平等多重因素干扰，稳定性难以保障； 各类智能化手术导航系统受术中眼部状态干扰，临床应用效能未达理论预期。术后阶段，现有IOL光学设计与材料存在固有局限性，后发性白内障(PCO)的远期防控难题，仍是制约患者长期优质视觉质量的核心因素。文章系统梳理RCS围术期术前、术中、术后各阶段的精准诊疗难点与核心挑战，结合跨设备误差补偿模型、人工智能辅助决策、术前VR视觉模拟、智能化手术生态平台搭建等前沿技术方向，针对性梳理解决方案与优化路径，旨在为RCS精准诊疗的临床规范化开展、技术革新及相关科研研究提供参考与借鉴。
[Key word]
[Abstract]
Modern cataract surgery has completely moved beyond the traditional vision-restoring model and has fully entered a new era of refractive cataract surgery(RCS)centered on precise refractive correction. Its core objective is to provide patients with personalized visual experiences characterized by full-range, clear, and comfortable vision. Currently, although diagnostic and therapeutic technologies for RCS are rapidly evolving, there remain many bottlenecks in the precise management of the entire perioperative process that urgently need to be addressed. Preoperatively, the measurement consistency among ocular biometry devices based on different detection principles remains poor, and systematic measurement errors cannot be completely eliminated. Moreover, the individualized selection of intraocular lenses(IOLs)relies heavily on surgeons' clinical experience, lacking a standardized quantitative decision-making framework, which makes it difficult to achieve precise personalized matching. Intraoperatively, the quality of continuous curvilinear capsulorhexis is affected by multiple factors such as ocular anatomical characteristics and surgical proficiency, and its stability cannot be reliably ensured. Various intelligent surgical navigation systems are compromised by intraoperative ocular conditions, and their clinical performance fails to meet theoretical expectations. At the postoperative stage, existing IOL optical designs and materials have inherent limitations. The longterm prevention and control of posterior capsule opacification(PCO)remains a core factor restricting patients' long-term high-quality visual outcomes. This article systematically reviews the precise diagnostic and therapeutic challenges and core bottlenecks across the preoperative, intraoperative, and postoperative stages of RCS. It further explores frontier technological directions—including cross-device error compensation models, artificial intelligence-assisted decision-making, preoperative VR-based visual simulation, and the construction of intelligent surgical ecosystem platforms—to delineate targeted solutions and optimization pathways. This review aims to provide references and insights for the standardized clinical implementation, technological innovation, and future research endeavors in precision diagnosis and treatment of RCS.
[中图分类号]
[基金项目]
辽宁省区研究所科研基金项目(No.LNI2025X10); 爱尔眼科集团科研基金项目(No.AIF2302D01); 湘江公益基金会技术创新与应用发展专项项目(No.KY24003)
