目的：研究不同手术方式对轴性高度近视合并白内障患者手术前后前房深度(ACD)、眼轴长度(AL)以及角膜曲率(K)的变化，以及对术后屈光误差(MFE)的影响。

方法：选取我院行白内障联合人工晶状体(IOL)植入术患者126例126眼，依据不同手术方式与AL将其分为3组：A组42例42眼为高度近视合并白内障患者，行白内障超声乳化吸除联合IOL植入术； B组42例42眼为高度近视合并白内障患者，行小切口白内障囊外摘除术联合IOL植入术； C组42例42眼为正常眼轴合并白内障患者，行白内障超声乳化吸除联合IOL植入术。测量3组患者术前1d和术后3mo的ACD、AL、K及视力值，并行统计学分析。

结果：A、B两组间术前、术后ACD变化(△ACD)和AL变化(△AL)均无差异。A、B组与C组间△ACD、△AL均有差异(均P<0.01)。三组△ACD与△AL均呈现正相关(r_A组=0.855，r_B组=0.856，r_C组=0.639，均P<0.05)，三组术前AL、△AL、△ACD与MFE均呈正相关(r_A组=0.874、0.877、0.858，r_B组=0.875、0.879、0.858，r_C组=0.428、0.766、0.862，均P<0.05)。A、B两组标准化回归系数△AL>△ACD(1.32、1.31倍)，C组标准化回归系数△ACD>△AL(1.66倍)。

结论：不同手术方式对轴性高度近视合并白内障患者术后的K值和MFE无明显影响，其术后MFE的主要影响因素是手术前后AL的变化，正常眼轴患者术后MFE更多因为ACD的变化。

METHODS: A total of 126 patients(126 eyes)performed cataract combined with intraocular lens(IOL)implantation were selected and divided into 3 groups according to different surgical approaches and axial length. Group A included 42 patients(42 eyes)who had cataract combined with high myopia and were performed cataract phacoemulsification combined with IOL implantation; Group B included 42 patients(42 eyes)who had cataract combined with high myopia and underwent small incision cataract extracapsular extraction combined with IOL implantation; Group C included 42 patients(42 eyes)who had cataract with normal axial length and underwent cataract phacoemulsification combined with IOL implantation. Then, the ACD, AL, K value and visual acuity of the three groups at 1d before operation and 3mo after operation were measured, and statistical analysis was performed.

RESULTS: The differences in the mean values of preoperative and postoperative changes in ACD(△ACD)and AL(△AL)between groups A and B showed no statistical significance. The differences in the mean values of △ACD and △AL between groups A and C and groups B and C were both statistically significant(both P<0.01). △ACD and △AL in all three groups showed positive correlation(r_A=0.855, r_B=0.856, r_C=0.639, all P<0.05). Furthermore, preoperative AL, △AL, △ACD and MFE in all three groups showed positive correlation(r_A=0.874, 0.877, 0.858, r_B=0.875, 0.879, 0.858, r_C=0.428, 0.766, 0.862, all P<0.05). The standardized regression coefficients of groups A and B were △AL>△ACD(1.32 and 1.31 times), and the standardized regression coefficients of group C were △ACD>△AL(1.66 times).

CONCLUSION: Different surgical procedures had no significant effect on the postoperative K value and MFE in patients with high axial myopia combined with cataract, of which main influencing factor is the change in the AL before and after surgery. The postoperative MFE in patients with normal AL was more due to the change of ACD.