目的：比较水平、斜轴、垂直植入散光型有晶状体眼后房型人工晶状体(TICL)后临床疗效、拱高及旋转稳定性。

方法：回顾性队列研究。收集2018-07/2022-03在武汉普瑞眼科医院植入TICL后至少规律随访1 a(术后1 d，1 wk，1、3、6 mo，1 a)的患者资料共92例120眼，根据TICL轴位在眼内的方位分三组：水平放置组(34例45眼)、斜轴放置组(25例29眼)、垂直放置组(33例46眼)。对比患者术后的裸眼视力(UDVA)及最佳矫正视力(CDVA)、屈光度、拱高及旋转角度(TICL实际轴位与预期轴位的偏差)。

结果：所有患者手术均顺利完成，术后均未出现感染、继发性青光眼、晶状体混浊等并发症。手术安全性及有效性：三组患者术后1 a的CDVA均优于或等于术前CDVA，三组患者的术后UDCA及CDVA均无差异(P>0.05)。术后1 a，三组患者安全性指数分别为1.34±0.21、1.34±0.17和1.31±0.18，有效性指数分别为1.26±0.21、1.33±0.18、1.27±0.16，均无差异(P>0.05)。拱高：三组患者术后不同时间的拱高有显著差异(P=0.003)，垂直组<水平组<斜轴组。三组组内不同随访时间点的拱高有差异(P<0.001)，均随时间推移呈下降趋势。残留散光：三组患者的残留散光无显著差异(P=0.130)，组内不同随访时间点的残留散光有差异(P<0.001)。旋转角度：三组患者的旋转角度无显著差异(P=0.135)，组内不同随访时间点的旋转角度有差异(P<0.001)。

结论：不同方位植入TICL均具有良好的安全性、有效性，术后旋转稳定性均良好，临床上可根据情况选用合适的角度植入TICL。

METHODS: Retrospective cohort study. A total of 92 cases(120 eyes)who underwent TICL implantation from July 2018 to March 2022 and had regular follow-up for at least 1 a postoperatively(1 d, 1 wk, 1, 3, 6 mo, and 1 a)at Wuhan Bright Eye Hospital were collected. The patients were divided into three groups, with 34 cases(45 eyes)in horizontal implantation group, 25 cases(29 eyes)in oblique implantation group(29 cases), and 33 cases(46 eyes)in vertical implantation group. Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), diopters, vault, and rotation angle(deviation of the actual axis of TICL from the expected axis).

RESULTS: All surgeries were uneventful, and there were no complications such as infection, secondary glaucoma, or cataract opacity. Safety and efficacy of the surgery: the CDVA of the three groups of patients was better than or equal to the preoperative CDVA at 1 a postoperatively, and there was no statistically significant differences in postoperative UDVA and CDVA of the three groups(P>0.05). The safety index at 1a postoperatively was 1.34±0.21, 1.34±0.17, and 1.31±0.18 for the horizontal, oblique, and vertical groups, respectively. The efficacy index was 1.26±0.21, 1.33±0.18, and 1.27±0.16 for the three groups, respectively, both with no statistically significant differences(P>0.05). Vault: there was a significant difference in postoperative vault among the three groups(P=0.003), with the vertical group having the lowest vault, followed by the horizontal group and the oblique group. The vaults at different follow-up time points within each group showed significant differences(P<0.001), and all decreased over time. Residual astigmatism: there was no significant difference in residual astigmatism among the three groups(P=0.130), but there were differences at different follow-up time points within each group(P<0.001). Rotation angle: no significant differences in rotation angle were observed among the three groups(P=0.135), but there were differences at different follow-up time points within each group(P<0.001).

CONCLUSION: The implantation of TICL in different orientations has good safety and efficacy, the postoperative rotational stability is good, and the appropriate angle can be selected to implant TICL according to the clinical situation.