目的：量化评估不同切口位置对有晶状体眼后房型人工晶状体(ICL)植入术所致术源性散光(SIA)的矢量影响，明确角膜前、后表面在SIA形成中的相对贡献。

方法：前瞻性纳入2023年7月1日至2024年1月1日行ICL/TICL植入术的患者，根据预期残留散光轴向分为上方切口组与颞侧切口组。于术前及术后3 mo采用Pentacam测量全角膜屈光力、前后表面曲率半径，计算前、后表面屈光力及总角膜散光。采用Thibos矢量分析法将散光分解为J0与J45分量，计算各层面J0变化量(ΔJ0)。采用多元线性回归分析前、后表面ΔJ0及切口位置对总角膜ΔJ0的影响。

结果：本研究纳入患者162例162眼，上方切口组75例75眼，颞侧切口组87例87眼。完成随访154例154眼，上方切口组72例72眼(男17例，女55例，年龄25.96±6.17岁)，颞侧切口组82例82眼(男20例，女62例，年龄27.79±6.47岁)。上方切口组术后总角膜及前表面J0向正值(逆规化)转变(ΔJ0分别为0.146±0.108、0.199±0.117 D)，后表面J0向负值(顺规化)转变(ΔJ0=-0.050±0.022 D)； 颞侧切口组呈相反变化趋势。多元回归分析显示，模型拟合优度极佳(调整R2=0.943)，前表面ΔJ0是主要影响因素(B=0.968，β=1.137，P<0.001)，后表面ΔJ0亦具有显著贡献(B=1.018，β=0.297，P<0.001)。切口位置及其与前、后表面ΔJ0的交互项无差异(均P>0.05)。

结论：基于术后3 mo随访，上方切口诱导的SIA偏向逆规散光，颞侧切口诱导的SIA偏向顺规散光； 前表面SIA是总角膜SIA的主要贡献因素，后表面亦表现出统计学上显著的关联。

METHODS: A prospective study was conducted on who underwent ICL/toric ICL implantation between July 1, 2023 and January 1, 2024. Patients were divided into superior incision group and temporal incision group according to the expected postoperative residual astigmatism. Pentacam measurements were performed preoperatively and at 3 mo postoperatively to obtain total corneal refractive power and anterior and posterior corneal curvature radii. Anterior and posterior corneal surface powers and total corneal astigmatism were calculated. Thibos vector analysis was applied to decompose corneal astigmatism into orthogonal components J0 and J45, and the changes in J0(ΔJ0)were calculated for each surface. Multiple linear regression analysis was performed to explore the associations of anterior surface ΔJ0, posterior surface ΔJ0, and incision location with total corneal ΔJ0.

RESULTS: This study included 162 patients(162 eyes), with 75 patients 75 eyes in the superior incision group and 87 patients 87 eyes in the temporal incision group. Totally 154 patients(154 eyes)completed follow-up: 72 patients(72 eyes)in the superior incision group(17 males and 55 females, aged 25.96±6.17 y)and 82 patients(82 eyes)in the temporal incision group(20 males and 62 females, aged 27.79±6.47 y). In the superior incision group, the total cornea and anterior surface J0 shifted toward positive values(against-the-rule), with ΔJ0 of 0.146±0.108 D and 0.199±0.117 D, respectively, while the posterior surface J0 shifted toward negative values(with-the-rule), with ΔJ0 of -0.050±0.022 D. The temporal incision group showed the opposite trend. Multiple regression analysis showed an excellent model fit(adjusted R2=0.943), with anterior surface ΔJ0 as the main influencing factor(B=0.968, β=1.137, P<0.001)and posterior surface ΔJ0 also contributing independently and significantly(B=1.018, β=0.297, P<0.001). Incision location and its interaction terms with anterior and posterior surface ΔJ0 were not statistically significant(all P>0.05).

CONCLUSION: Based on 3 mo postoperative followup, superior incisions induce a predominant withtherule SIA vector, while temporal incisions induce a predominant againsttherule SIA vector. Anterior surface ΔJ0 is the primary contributor to total corneal ΔJ0, and posterior surface ΔJ0 also demonstrates a statistically significant association.