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中华眼科医学杂志(电子版) ›› 2026, Vol. 16 ›› Issue (03) : 174 -178. doi: 10.3877/cma.j.issn.2095-2007.2026.03.009

综述

晶状体与人工晶状体倾斜及偏心的研究进展
林品妤, 李猛, 万修华()   
  1. 100730 首都医科大学附属北京同仁医院北京同仁眼科中心 北京市眼科学与视觉科学重点实验室
  • 收稿日期:2026-05-24 出版日期:2026-06-28
  • 通信作者: 万修华
  • 基金资助:
    国家自然科学基金资助项目(82171037)

Advances in crystalline lens and intraocular lens tilt and decentration

Pinyu Lin, Meng Li, Xiuhua Wan()   

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
  • Received:2026-05-24 Published:2026-06-28
  • Corresponding author: Xiuhua Wan
引用本文:

林品妤, 李猛, 万修华. 晶状体与人工晶状体倾斜及偏心的研究进展[J/OL]. 中华眼科医学杂志(电子版), 2026, 16(03): 174-178.

Pinyu Lin, Meng Li, Xiuhua Wan. Advances in crystalline lens and intraocular lens tilt and decentration[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2026, 16(03): 174-178.

人工晶状体(IOL)在囊袋内的倾斜及偏心可引起高阶像差、眩光、对比敏感度下降及单眼复视,功能型IOL对位置异常尤为敏感。准确评价术前天然晶状体及术后IOL的空间位置,对于功能型IOL选择、手术方案制定及术后视觉质量解释具有重要意义。CASIA2将扫频源光学相干断层扫描(OCT)与前节三维重建技术结合,可同时识别角膜、虹膜、晶状体或IOL的前后表面,并以内置算法计算倾斜度、偏心量及方向。CASIA2扫频源前节OCT以角膜地形图轴为参照,无需睫状肌麻痹即可对晶状体及IOL位置进行三维定量分析。目前,术前晶状体位置与术后IOL位置关系,术前CASIA2联合眼部生物测量对术后位置异常的风险分层和IOL个体化选择尚未明确。本文中笔者围绕IOL倾斜和偏心的临床意义、CASIA2的测量原理与技术优势、天然晶状体的位置特征、术后IOL的位置特征、眼部生物测量参数、高度近视眼、玻璃体切除术史及IOL设计等影响因素以及术前晶状体位置的预测价值进行综述。

Tilt and decentration of an intraocular lens (IOL) within the capsular bag may induce higher-order aberrations, glare, reduced contrast sensitivity, and monocular diplopia; presbyopia-correcting and toric IOL are particularly sensitive to misalignment. Accurately evaluating the spatial positions of the natural crystalline lens before surgery and IOL after surgery is of great significance for the selection of functional IOL, the formulation of surgical plans, and the interpretation of postoperative visual quality. CASIA2 combines swept-source optical coherence tomography (OCT) with anterior segment three-dimensional reconstruction technology, enabling simultaneous identification of the anterior and posterior surfaces of the cornea, iris, lens, or IOL, and calculating the tilt, decentration, and orientation using built-in algorithms. CASIA2 swept-source anterior segment OCT uses the corneal topographic axis as a reference and enables three-dimensional quantification of crystalline lens and IOL position without pharmacologic dilation. The relationship between preoperative crystalline lens position and postoperative IOL position, as well as the value of combining preoperative CASIA2 measurements with ocular biometry for risk stratification of postoperative IOL malposition and individualized IOL selection, remains unclear. The clinical relevance of IOL tilt and decentration, the measurement principles and technical advantages of CASIA2, the positional characteristics of the crystalline lens and postoperative IOL, and associated factors including ocular biometry, high myopia, previous vitrectomy, and IOL design were summarized. The predictive value of preoperative crystalline lens position was also discussed.

图1 CASIA2测量人工晶状体倾斜与偏心示意图 注:倾斜θ为IOL轴线相对于角膜地形图轴的夹角;偏心d为人工晶状体中心至角膜地形图轴的垂直距离
图2 CASIA2测量人工晶状体倾斜与偏心示例图 可见右眼人工晶状体相对于角膜地形图轴的三维倾斜度为6.0°,方位角135°,表现为向颞上方倾斜;三维偏心量为0.27 mm,方位角93°,表现为主要向上方、略向颞侧偏心。当前0°~180°水平截面内,人工晶状体倾斜分量为-4.2°,偏心分量为-0.03 mm。该患者倾斜6.0°,偏心0.27 mm,均小于临床显著倾斜(7°)和偏心(0.4 mm)阈值。但该阈值并非为普遍适用的诊断标准,仍需结合人工晶状体类型、视力、屈光误差、眩光或重影症状、瞳孔大小及高阶像差综合判断
表1 常用晶状体及人工晶状体倾斜和偏心测量方法比较
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