目的

探讨Pentacam测量SimK联合角膜后表面散光、IOLMaster 700测量SimK及IOLMaster 700测量全角膜散光（TK）三种角膜散光测算方式对散光矫正型IOL术后屈光预测的准确性。

方法

收集2022年9月至2024年12月期间在首都医科大学附属北京同仁医院眼科中心行超声乳化白内障吸除联合散光矫正型人工晶状体（IOL）植入术的白内障患者34例（34只眼）。其中，男性15例（15只眼），女性19例（19只眼）；年龄28～83岁，平均年龄（57.7±16.9）岁。全部患者分别采用Pentacam测量SimK联合角膜后表面散光、IOLMaster 700测量SimK及IOLMaster 700测量TK三种方式检测患者手术前和术后3个月的裸眼远视力、最佳矫正视力、主觉验光结果、术前眼轴长度、中央前房深度、晶状体厚度、角膜直径及角膜曲率。将获得的角膜散光参数分别代入Barrett Toric IOL计算公式，计算IOL屈光度并预测术后屈光度。通过矢量法计算三种测算方式术后3个月患者的预测误差（PE）、平均绝对误差（MAE）、质心误差及误差分布百分比，采用例数（眼数）和百分比描述。分别记数三种方式检测患者术前的顺规散光（WTR）和逆规散光（ATR），以例数（眼数）及百分比描述。年龄、眼轴长度、角膜曲率、植入IOL的屈光度及MAE等均符合正态分布以±s表示，手术前后比较采用配对t检验。三种测算方式间的比较采用单因素重复测量方差分析，当差异有统计学意义时，进一步两两比较。三种测算方式间比较采用卡方检验。

结果

患者术前角膜散光和术后残余角膜散光分别为（2.76±1.10）D和（0.65±0.51）D，差异具有统计学意义（t＝15.760，P＜0.05）。Pentacam实测后表面、Master SimK及Master TK三种测算方式的MAE分别为（0.63±0.36）D、（0.65±0.35）D及（0.65±0.39）D，Pentacam实测后表面的MEA低于Master SimK，差异具有统计学意义（t＝-2.360，P＜0.05）；三种测算方式应用于全体患者均表现出顺规方向的质心误差。其中Master SimK质心误差最大，为（0.19±0.72）D＠119°；三种测算方式预测误差在±0.50 D以内者分别为20例（20只眼）、15例（15只眼）及17例（17只眼），分别占58.8%、44.1%及50.0%。

结论

相对于IOLMaster SimK，IOLMaster TK与Pentacam测量SimK联合角膜后表面散光均可提供更高的散光矫正型IOL术后屈光预测准确性。角膜后表面散光数据可通过优化全角膜散光评估来提高散光矫正型IOL植入术后屈光预测的准确性。

Objective

To evaluate the accuracy of three corneal astigmatism measurement methods Pentacam SimK＆posterior corneal astigmatism，IOLMaster 700 SimK，and IOLMaster 700 total keratometry（TK）in predicting postoperative refractive outcomes after toric intraocular lens（IOL）implantation.

Methods

A total of 34 patients（34 eyes）with cataracts who underwent phacoemulsification cataract removal combined with Toric IOL implantation at the Ophthalmology Center of Beijing Tongren Hospital affiliated with Capital Medical University from September 2022 to December 2024 were enrolled.Among them，there were15 patients（15 eyes）male and 19 patients（19 eyes）female with an average age of（57.7±16.9）years（ranging from 28 to 83 years）.All patients were examined using three methods：Pentacam measuring SimK combined with posterior corneal surface astigmatism，IOLMaster 700 measuring SimK，and IOLMaster 700 measuring TK.These examinations were conducted for uncorrected distance visual acuity，best corrected visual acuity，subjective refraction results，preoperative axial length，central anterior chamber depth，lens thickness，corneal diameter，and corneal curvature both before surgery and 3 months postoperatively.The obtained corneal astigmatism parameters were substituted into the Barrett Toric IOL calculation formula to compute IOL refractive power and predict postoperative refractive power.The vector method was used to calculate the prediction error（PE），mean absolute error（MAE），centroid error，and error distribution percentage for the three measurement methods 3 months postoperatively.The number and percentage of patients with preoperative with-the-rule（WTR）and against-the-rule（ATR）astigmatism were recorded for the three detection methods.Age，axial length，corneal curvature，IOL refractive power，and MAEall followed a normal distribution and expressed as±s.Paired t test were used for comparisons before and after surgery.Gender，eye side，and error distribution were described using counts（number of eyes）and percentages.One way repeated measures ANOVA was used to compare the three measurement methods.When the difference was statistically significant，further pairwise comparison was made.Chi square test was used to compare the three measurement methods.

Results

Preoperative corneal astigmatism and postoperative residual corneal astigmatism were（2.76±1.10）Dand（0.65±0.51）D，respectively，with a statistically significant difference（t＝15.760，P＜0.05）.MAE of Pentacam measured posterior surface，Master SimK，and Master TK were（0.63±0.36）D，（0.65±0.35）D，and（0.65±0.39）D，respectively.The Pentacam measured posterior surface had a lower MAE compared to Master SimK，with a statistically significant difference（t＝-2.360，P＜0.05）.Three methods showed centroid errors in the WTR direction，with Master SimK having the largest centroid error of（0.19±0.72）D＠119°.The number of cases with prediction errors within±0.50 D were 20 cases（20 eyes），15 cases（15 eyes），and 17 cases（17 eyes），accounting for 58.8%，44.1%，and 50.0%，respectively.

Conclusions

Compared to IOLMaster 700 SimK，both IOLMaster 700 TK and Pentacam-measured SimK combined with posterior corneal astigmatism provided higher accuracy in predicting postoperative refraction after Toric IOL implantation.Incorporating posterior corneal astigmatismdata can optimize total corneal astigmatism assessment，thereby improving refractive prediction accuracy following Toric IOL surgery.