Table 1_Refractive error after phacoemulsification combined with intraocular lens implantation in primary angle-closure glaucoma: a multifactorial analysis of biometric parameters and surgical strategies.docx

PurposeThis study aims to explore the factors influencing refractive error following Phacoemulsification combined with intraocular lens implantation (PE + IOL) in patients with primary angle-closure glaucoma (PACG), providing a theoretical basis for preoperative consultation and IOL power selection in clinical practice.
MethodsA retrospective analysis was conducted on 404 PACG patients from Shenzhen Eye Hospital between 2019 and 2024. Preoperative ocular biometric parameters and combined surgical approaches were evaluated using Spearman correlation, multinomial logistic regression, and receiver operating characteristic (ROC) curve analysis.
ResultsAxial length (AL), lens thickness (LT), and white-to-white distance (WTW) were key predictive factors for prediction error and postoperative refractive outcomes. AL > 22.56 mm (AUC = 0.692) and LT > 5.055 mm (AUC = 0.633) increased the risk of myopic shift (MS), while AL < 22.25 mm (AUC = 0.604) and WTW <11.55 mm (OR = 2.209, P = 0.001) were associated with hyperopic shift (HS). The axial length/corneal radius (AL/CR) ratio >2.986 further indicated a higher risk of MS (AUC = 0.639) postoperatively. Among patients who underwent PE + IOL combined with capsular tension ring, the proportion of HS was significantly higher (Z value = +2.95).
ConclusionThe unique anatomical characteristics of PACG patients are key contributors to postoperative refractive instability. Preoperative assessment for PE + IOL surgery should comprehensively evaluate AL, LT, WTW, and AL/CR ratio. When combined with other surgical approaches to control intraocular pressure, IOL power should be adjusted according to these thresholds to ensure postoperative refractive stability.

研究目的
本研究旨在探讨原发性闭角型青光眼（primary angle-closure glaucoma, PACG）患者行白内障超声乳化联合人工晶状体植入术（PE + IOL）后屈光误差的影响因素，为临床术前咨询与人工晶状体（intraocular lens, IOL）度数选择提供理论依据。
研究方法
本研究回顾性分析了2019年至2024年深圳眼科医院的404例PACG患者。采用斯皮尔曼相关分析、多项logistic回归及受试者工作特征（receiver operating characteristic, ROC）曲线分析，对患者术前眼生物测量参数与联合手术方式进行评估。
研究结果
眼轴长度（axial length, AL）、晶状体厚度（lens thickness, LT）及白对白距离（white-to-white distance, WTW）是预测误差与术后屈光结局的关键预测因素。眼轴长度＞22.56mm（曲线下面积AUC=0.692）与晶状体厚度＞5.055mm（AUC=0.633）会增加近视漂移（myopic shift, MS）风险；而眼轴长度＜22.25mm（AUC=0.604）与白对白距离＜11.55mm（比值比OR=2.209，P=0.001）则与远视漂移（hyperopic shift, HS）相关。眼轴/角膜曲率半径（AL/CR）比值＞2.986可进一步提示术后近视漂移风险更高（AUC=0.639）。在接受PE+IOL联合囊袋张力环手术的患者中，远视漂移占比显著更高（Z值=+2.95）。
研究结论
PACG患者独特的解剖特征是术后屈光不稳定的关键诱因。PE+IOL手术的术前评估应全面评估眼轴长度、晶状体厚度、白对白距离及AL/CR比值。若联合其他手术方式控制眼压，则应根据上述阈值调整人工晶状体度数，以保障术后屈光稳定性。