目的：研究后房型人工晶状体(IOL)巩膜层间固定术后屈光状态。方法：回顾性临床研究。选取2017-03/2021-12于北京大学国际医院行后房型IOL巩膜层间固定术的患者55例55眼。根据手术步骤不同分为常规组(35眼)及改良组(20眼)。应用IOL Master光学生物测量仪及SRK/T公式计算IOL屈光度及预留屈光度，记录术前角膜散光值。术后1、3mo行验光，IOL Master光学生物测量仪及Pentacam眼前段分析仪检查，记录术后角膜散光及总散光值，计算等效球镜度数作为实际屈光度。采用Image-pro plus图像分析软件计算IOL倾斜度及偏心值。结果：患者55眼后房型IOL巩膜层间固定术后呈现远视漂移，术后3mo患者屈光误差为0.75±0.63D。术后3mo实际屈光度与术前预留屈光度有差异(t=2.553，P=0.011)。无论常规组或改良组，术后均表现为远视漂移。常规组术后1、3mo屈光误差为0.80±0.43、0.84±0.46D，改良组术后1、3mo屈光误差为0.43±0.39、0.47±0.26D，两组间比较均有差异(1mo：t=3.500，P=0.001； 3mo：t=3.311，P=0.002)。术后1、3mo，两组间角膜散光无差异(均P>0.05)。两组间总散光比较，改良组均低于常规组(1mo：t=3.884，P<0.001； 3mo：t=3.314，P=0.002)。改良组术后1、3mo IOL倾斜度及偏心值均低于常规组(均P<0.05)。组内比较：两组术后1mo与术后3mo IOL倾斜度及偏心值均无差异(P>0.05)。患者55眼中，术后2眼一过性眼压升高，2眼一过性低眼压，药物治疗后恢复，1眼玻璃体积血自行吸收。结论：后房型IOL巩膜层间固定术安全有效，术后存在远视漂移。增加植入IOL屈光度，术前预留轻度近视可预防术后远视化，但长期效果仍需进一步观察。

AIM: To evaluate the refractive outcomes after intrascleral fixation of posterior intraocular lens(IOL).METHODS: Retrospective clinical study. A total of 55 patients(55 eyes)who had undergone intrascleral fixation of posterior IOL in Peking University International Hospital from March 2017 to December 2021 were enrolled. Patients were assigned to conventional group(35 eyes)and modified group(20 eyes)according to different surgical procedures. IOL Master combined with SRK/T formula were applied to calculate the diopter of IOL and the residual refractive power, as well as acquiring preoperative values of corneal astigmatism. Optometry, IOL Master and Pentacam were performed 1 and 3mo postoperatively to obtain the postoperative corneal astigmatism, total ocular astigmatism and spherical equivalent which was calculated as the actual diopter. The Image-pro plus analyzer was used to measure the values of IOL tilt and decentration.RESULTS: The 55 eyes that underwent intrascleral fixation of posterior IOL presented hyperopic shift in refraction after operation and the refractive error was 0.75±0.63D at 3mo postoperatively. There was significant difference between the actual diopter and the residual diopter at 3mo after operation(t=2.553, P=0.011). Both conventional group and modified group showed hyperopic shift postoperatively. The refractive error at 1 and 3mo after operation were 0.80±0.43 and 0.84±0.46D in the conventional group and 0.43±0.39 and 0.47±0.26D in the modified group respectively, with significant differences between two groups(1mo: t=3.500, P=0.001; 3mo: t=3.311, P=0.002). There was no significant difference in corneal astigmatism between two groups both at 1 and 3mo postoperatively(all P<0.05). Total ocular astigmatism in the modified group was significantly lower than that in the conventional group(1mo: t=3.884, P<0.001; 3mo: t=3.314, P=0.002). In addition, IOL tilt and decentration in the modified group were significantly less than that in the conventional group at 1 and 3mo postoperatively(all P<0.05). No significant difference was found in IOL tilt and decentration for intra-group comparison at 1 and 3mo postoperatively(P<0.05). Complications of 55 eyes included 2 eyes of transient intraocular pressure elevation, 2 eyes of transient hypotony which recovered after topical medication and 1 eye of vitreous hemorrhage which resolved spontaneously.CONCLUSION: Intrascleral fixation of posterior IOL is proved to be a safe and effective surgical technique, with hyperopic shift easily present after operation. Increasing the refractive power of IOL and targeting mild myopia during IOL power calculation can prevent postoperative hyperopia, but long-term outcomes still need further observation.

北京大学国际医院院内科研基金中青年启动项目(No.YN2021QN04)