随着年龄的增长，越来越多有晶状体眼后房型人工晶状体(ICL)植入患者面临白内障对视力的威胁。此类患者白内障术前眼部检查时应该关注角膜内皮细胞密度是否大于2 000个/mm 2、前房角的开放状态以及是否有视网膜脱离、脉络膜新生血管等眼底异常；眼部生物测量时应该关注前房深度和晶状体厚度的测量起止线，若行ICL联合角膜屈光手术的患者要按照角膜激光手术后的检查要求使用2种以上设备测量角膜屈光力；人工晶状体类型选择时要考虑高度近视眼的组织结构特点，相较于C形与L形襻，平板襻在高度近视伴有大囊袋以及较大的撕囊直径患者中相对更为稳定；Kane、Barrett Universal Ⅱ、Olsen、Hill-RBF等人工晶状体屈光度计算公式在长眼轴人群中相对准确；推荐ICL取出与白内障超声乳化和人工晶状体植入术同时进行，手术切口宜大于2.6 mm。飞秒激光辅助的白内障摘除手术，虽然在减少角膜内皮细胞丢失、减轻角膜水肿、高质量撕囊等方面优于传统超声乳化白内障吸除术，但因ICL的存在会引起飞秒切削气泡聚积、需要手动调整激光扫描定位以及较低拱高，可造成撕囊和碎核的不完全，建议谨慎使用。眼科医师应充分认识和关注ICL术后白内障手术的特点和设计的难点，与患者充分沟通交流，个性化选择，以期获得更佳的视觉效果。
With increasing age, more and more patients with posterior chamber intraocular lens (ICL) implantation are facing the threat of cataracts to their visual acuity.When examining the eyes of cataract patients after ICL surgery, attention should be paid to whether the density of corneal endothelial cells is greater than 2 000 cells/mm 2, the state of the anterior chamber angle, and whether there are fundus abnormalities such as retinal detachment and choroidal neovascularization.When conducting eye biometry measurement, attention should be paid to the measurement starting and ending lines of anterior chamber depth and lens thickness.If patients undergo ICL combined with corneal refractive surgery, they should be examined with two or more devices to obtain corneal refractive power according to the examination requirements after corneal laser vision correction.When selecting the type of intraocular lens, consideration should be given to the histological characteristics of high myopia.Compared to C- and L- loops, plate-haptic is relatively more stable in patients with high myopia accompanied by large capsules and larger diameters of continuous curvilinear capsulorhexis.Kane, Barrett Universal Ⅱ, Olsen, Hill-RBF formulas for calculating the refractive power of intraocular lenses are more accurate in people with long axial length.It is recommended to perform ICL removal simultaneously with phacoemulsification and intraocular lens implantation, preferably with a surgical incision greater than 2.6 mm.Femtosecond laser assisted cataract extraction surgery, although superior to traditional phacoemulsification in reducing corneal endothelial cell loss, reducing corneal edema, and high-quality capsulorhexis, can cause incomplete capsulorhexis and fragmentation due to the cavitation bubbles, manual adjustment of location, and the impact of lower vault.It is recommended to use it with caution.Ophthalmologists should fully understand and pay attention to the characteristics and difficulties of cataract surgery after ICL surgery, communicate fully with patients, and make personalized surgery to achieve better visual outcomes.
王晓瑛,周行涛,竺向佳,等. 关注有晶状体眼后房型人工晶状体植入术后白内障手术要点[J]. 中华实验眼科杂志,2024,42(03)：219-223.
DOI:10.3760/cma.j.cn115989-20230815-00070版权归中华医学会所有。
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