观察在无黏弹剂辅助下植入人工晶状体(ICL)后，不同屈光不正组患者的瞳孔直径和瞳孔动力变化。

收集2019年8月至2021年1月期间于中国北京安贞医院眼科接受ICL V4c植入术的53例(104只眼)患者的病例资料。其中，男性11例(22只眼)，女性42例(82只眼)；年龄21～48岁，平均年龄(33.5±6.9)岁。根据患者术前等效球镜屈光度分为中低度近视眼组和高度近视眼组。检查所有患者的眼压、等效球镜、前房深度、中央角膜厚度、白到白直径及瞳孔直径。年龄、眼压、瞳孔直径及瞳孔动力变化等计量资料经过正态性检验，服从正态分布，以±s表示，组间比较采用独立样本t检验，组内术前术后比较采用配对t检验；等效球镜不服从正态分布以中位数(四分位间距)表示，组间比较采用Mann－Whitney U检验，组内前后比较采用Wilcoxon符号秩和检验。性别以例和百分比表示，组间比较采用χ²检验。两组间术前术后瞳孔动力变化趋势的相关性采用Pearson或者Spearman相关性分析。

在明光下，中低度近视眼组患者术前术后瞳孔直径分别为(4.16±0.60)mm和(3.99±0.65)mm，其差异有统计学意义(t＝2.338，P<0.05)；在暗光下，术前术后瞳孔直径分别为5.76(1.58)mm和5.48(1.13)mm，其差异无统计学意义(Z＝1.873，P>0.05)。中低度近视眼组患者在术后在明光下瞳孔直径明显缩小。在明光下，高度近视眼组患者术前术后瞳孔直径分别为4.18(1.00)mm和4.17(1.08)mm；在暗光下，术前术后瞳孔直径分别为(5.81±0.84)mm和(5.86±0.89)mm。在明光下，两组患者术后瞳孔直径比较差异均有统计学意义(Z＝－0.688，P<0.05)；在暗光下，术后瞳孔直径比较差异有统计学意义(t＝－0.02，P<0.05)。在明暗光下，中低度近视眼组患者术前术后瞳孔直径差分别为1.29(1.07)mm和(1.48±0.33)mm，其差异无统计学意义(Z＝－0.111，P>0.05)；高度近视眼组患者术前术后瞳孔直径差分别为(1.39±0.45)mm和(1.59±0.53)mm，其差异有统计学意义(t＝－3.265，P<0.05)；两组患者术前术后孔直径差值比较差异均无统计学意义(Z＝－0.306，－0.721；P>0.05)。在明光下，中低度近视眼组患者术后与术前瞳孔直径差值为(－0.17±0.48)mm；暗光下为－0.09(0.25)mm，均呈缩小趋势，其差异无统计学意义(Z＝0.000，P>0.05)。在明光下，高度近视眼组患者术后与术前瞳孔直径差值为－0.17(0.43)mm；在暗光下为(0.05±0.41)mm，其差异有统计学意义(Z＝2.411，P<0.05)，高度近视眼组患者暗光下术后瞳孔直径呈增大趋势。中低度近视眼组患者术前瞳孔动力与术后瞳孔动力经Spearman相关性分析，两者呈正相关性具有统计学意义(r＝0.587，P<0.05)。高度近视眼组患者术前瞳孔动力与术后瞳孔动力经Pearson相关性分析，两者呈正相关性具有统计学意义(r＝0.518，P<0.05)。

在无黏弹剂辅助植入ICL V4c会使中低度和高度近视眼组患者术后1个月的瞳孔直径在明光下瞳孔明显减小；高度近视患者术后瞳孔在暗光下瞳孔直径变化更大，更容易影响视觉质量。

The aim of this study is to evaluate the changes of pupil diameter and dynamics in patients with different ametropia after implantable collamer lens (ICL)V4c without viscoelastic agent.

A Total of 53 patients (104 eyes) who underwent ICL V4c implantation surgery in the Department of Ophthalmology, Anzhen Hospital in Beijing, China from August 2019 to January 2021 were collected. Among them, there were 11 males (22 eyes) and 42 females (84 eyes) with the average age of (33.5±6.9) years old (ranged from 21 to 48) years old. According to the preoperative equivalent spherical refractive index of patients, they are divided into moderate to low myopia group and high myopia group. The patient's intraocular pressure, equivalent spherical lens, anterior chamber depth, central corneal thickness, and white to white diameter, the pupil diameter before and one month after ICL V4c implantation were performed. Age, intraocular pressure, pupil diameter, and changes in pupil motility and other quantitative data have undergone normality tests and conformed to a normal distribution, were expressed as ±s, and compared by independent sample t-tests for inter group, and paired t-tests for intra group. Quantitative data with equivalent spherical mirrors that did not follow a normal distribution were expressed as median (interquartile range), and compared by Mann Whitney U test for inter group, and Wilcoxon signed rank test for intra group. Gender was expressed in examples and percentages, and compared by χ² for inter group. The correlation analysis between preoperative and postoperative changes in pupil dynamics between two groups was performed using Pearson or Spearman correlation analysis.

Under bright light, the preoperative and postoperative pupil diameters of patients in moderate to low degree myopia group were (4.16±0.60) mm and (3.99±0.65) mm, respectively, with a statistical significance difference between them (t=2.338, P<0.05). Under dark light, the preoperative and postoperative pupil diameters were 5.76 (1.58) mm and 5.48 (1.13) mm, respectively, with no statistically significant difference (Z=1.873, P>0.05). The pupil diameter of moderate to low degree myopia group significantly decreased under postoperative bright light. The preoperative and postoperative pupil diameter of the high myopia group was 4.18 (1.00) mm and 4.17 (1.08) mm, respectively. The differencewas statistically significant between the two groups (Z=2.978, P<0.05). The pupil diameters of the highly myopic group before and after surgery under bright light were 4.18 (1.00) mm and 4.17 (1.08) mm, respectively, with no statistically significant difference (t=-1.004, P>0.05). Under dark light, the preoperative and postoperative pupil diameters were (5.81±0.84) mm and (5.86±0.89) mm, respectively. There was no statistically significant difference in preoperative pupil diameter between the two groups (Z=-1.510, -2.030; P>0.05). Under bright light, the difference in postoperative pupil diameter between the two groups was statistically significant (Z=-0.688, P<0.05). Under dark light, the postoperative pupil diameter was statistically significant (t=-0.02, P<0.05). The difference in pupil diameter dynamics before and after surgery was 1.29 (1.07) mm and (1.48±0.33) mm in the moderate to low degree myopia group, respectively, and there was no statistically significant difference between them (Z=-0.111, P>0.05). The difference in pupil dynamics before and after surgery in the high myopia group was (1.39±0.45) mm, and (1.59±0.53) mm, with a statistical significance difference (t=-3.265, P<0.05). The postoperative changes in pupil dynamics in the high myopia group were significantly larger than that of before surgery. The difference in pupil diameter between the two groups before and after surgery was not statistically significant (Z=-0.306, -0.721; P>0.05). Under bright light, the difference between the postoperative and preoperative pupil diameter in the medium to low degree myopia group was (-0.17±0.48) mm, and under dark light that was -0.09 (0.25) mm, both showing a decreasing trend, with no statistically significant difference (Z=0.000, P>0.05). Under bright light, the difference in postoperative and preoperative pupil diameter in the high myopia group was -0.17 (0.43) mm, and under dark that was (0.05±0.41) mm with statistically significant between them (Z=2.411, P<0.05). The high myopia group showed an increasing trend in postoperative pupil diameter under dark. Spearman correlation analysis showed a positive correlation between the preoperative and the postoperative pupil dynamics with statistical significance in low degree myopia group (r=0.587, P<0.05). Pearson correlation analysis showed a positive correlation between the preoperative and postoperative pupil dynamics, with a statistical significance difference between them (r=0.518, P<0.05).

The pupil diameter of the patients with moderate to low myopia and high myopia can be significantly reduced after ICL V4c implantation for one month without viscoviscoid-assisted implantation under bright light. In patients with high myopia, the pupil diameter changes more greatly under light and dark lighting after surgery, which is more likely to affect the visual quality.