目的：研究三种不同的前囊切开中央定位技术(瞳孔中心、角膜缘中心和晶状体顶点)在飞秒激光辅助白内障手术(FLACS)后对人工晶状体(IOL)植入位置和视觉质量的影响。

方法：前瞻性研究。纳入2023-01/12在安徽医科大学附属爱尔眼科医学中心接受FLACS及ZCB00非球面IOL植入的36例72眼年龄相关性白内障患者。根据前囊切开的中央定位模式分为三组：瞳孔中心组、角膜缘中心组和晶状体顶点中心组。通过Casia2设备评估IOL的倾斜和偏心，并对术后视觉质量进行评价。

结果：术后1 d，瞳孔中心组、角膜缘中心组和顶点中心组的IOL倾斜度分别为3.96°±1.51°、4.63°±1.87°和3.90°±2.24°(F=1.07，P=0.35)； IOL偏心值分别为0.21±0.10 mm、0.23±0.16 mm和0.21±0.12 mm(F=0.14，P=0.87)； 总高阶像差分别为0.32±0.40 μm、0.56±0.61 μm和0.53±0.60 μm(F=1.38，P=0.26)； 彗差值分别为0.13±0.10 μm、0.16±0.15 μm和0.14±0.15 μm(F=0.30，P=0.74)。术后1 d的所有结果均无显著差异。术后3 mo，IOL倾斜度分别为5.42°±2.00°、3.96°±1.44°和3.20°±1.19°(F=12.40，P<0.001)； IOL偏心值分别为0.33±0.07 mm、0.23±0.11 mm和0.21±0.11 mm(F=4.99，P=0.008)； 总高阶像差分别为0.67±0.29 μm、0.44±0.37 μm和0.42±0.19 μm(F=5.50，P=0.006)； 彗差值分别为0.21±0.12 μm、0.19±0.12 μm和0.12±0.11 μm(F=3.87，P=0.03)。术后3 mo的所有结果均具有统计学意义。

结论：在FLACS中，采用晶状体顶点作为前囊切开的中央定位模式，可以改善术后IOL的稳定性，并减少术后IOL的倾斜和偏心。如果术中无法确定晶状体顶点，则建议采用角膜缘中心定位模式。

METHODS: A total of 36 patients(72 eyes)with age-related cataracts who underwent FLACS and ZCB00 aspherical IOL implantation at Aier Eye Hospital Medical Center, Anhui Medical University between January and December 2023 were included in this prospective study. Patients were divided into three groups based on the central positioning mode for anterior capsulotomy: pupil center, limbus center, and lens apex center groups. IOL alignment and displacement were evaluated using the Casia2 device, and the postoperative visual quality was assessed.

RESULTS: At 1 d postoperatively, the IOL tilt for the pupil, limbus, and apex groups were 3.96°±1.51°, 4.63°±1.87°, and 3.90°±2.24°, respectively(F=1.07, P=0.35); IOL decentration values were 0.21±0.10 mm, 0.23±0.16 mm, and 0.21±0.12 mm, respectively(F=0.14, P=0.87); total higher-order aberrations were 0.32±0.40 μm, 0.56±0.61 μm, and 0.53±0.60 μm, respectively(F=1.38, P=0.26); and coma aberrations values were 0.13±0.10 μm, 0.16±0.15 μm, and 0.14±0.15 μm, respectively(F=0.3, P=0.74). All results obtained postoperative day 1 did not differ significantly. At 3 mo postoperatively, IOL tilt values were 5.42°±2.00°, 3.96°±1.44°, and 3.20°±1.19°, respectively(F=12.40, P<0.001); IOL decentration values were 0.33±0.07 mm, 0.23±0.11 mm, and 0.21±0.11 mm, respectively(F=4.99, P=0.008); total higher-order aberrations were 0.67±0.29 μm, 0.44±0.37 μm, and 0.42±0.19 μm, respectively(F=5.50, P=0.006); and coma aberrations values were 0.21±0.12 μm, 0.19±0.12 μm, and 0.12±0.11 μm, respectively(F=3.87, P=0.03). All results obtained 3 mo postoperatively were statistically significant.

CONCLUSION: Using the lens apex as the central positioning mode for anterior capsulotomy in FLACS improves postoperative IOL stability and reduces postoperative IOL tilt and decentration. If the lens apex cannot be determined intraoperatively, the limbus center-positioning mode is recommended.