Early hyperopic shift after cataract surgery: A case report
白内障术后早期远视漂移1例

摘要

目的 分析白内障超声乳化联合人工晶状体（IOL）植入术后早期远视漂移的发生原因、影像学特点及处理原则，为提高屈光性白内障手术精准度提供临床依据。方法 回顾1例77岁男性2型糖尿病性白内障患者双眼先后手术、左眼术后早期远视漂移的临床资料，结合术前生物测量、术中操作、术后裂隙灯及眼前节光学相干断层扫描（前节OCT）检查，分析有效晶状体位置（ELP）改变与屈光漂移的关系。结果 右眼植入爱尔康SN60WF术后屈光稳定、视力良好；左眼植入蔡司601PY术后第1天出现明显远视，验光+1.50DS矫正视力0.5-，前节OCT提示IOL向后移位、ELP后移。随访1个月，随囊袋收缩愈合，IOL位置轻度前移，远视度数显著下降，矫正视力达0.7。结论 白内障术后早期远视漂移主要由IOL有效位置后移所致，IOL襻材质支撑性、囊袋愈合状态是关键影响因素。前节OCT可无创动态监测ELP变化，为诊断与处理提供可靠依据。重视术前评估、合理选择IOL、规范术中操作，可减少术后屈光漂移，提升视觉质量与手术安全性。

Abstract

Objective To analyze the causes, imaging characteristics and management principles of early hyperopic shift after phacoemulsification combined with intraocular lens (IOL) implantation, so as to provide clinical evidence for improving the accuracy of refractive cataract surgery.
Methods The clinical data of a 77-year-old male patient with type 2 diabetic cataract who underwent sequential bilateral surgery and developed early hyperopic shift in the left eye after surgery were retrospectively analyzed. Combined with preoperative biometry, intraoperative operation, postoperative slit-lamp and anterior segment optical coherence tomography (AS-OCT) examination, the relationship between changes in effective lens position (ELP) and refractive shift was analyzed.
Results The right eye implanted with Alcon SN60WF IOL achieved stable refraction and good visual acuity after surgery. On the first day after operation, the left eye implanted with Zeiss 601PY IOL showed obvious hyperopia with refraction of +1.50 DS and corrected visual acuity of 0.5-. AS-OCT indicated posterior displacement of IOL and backward shift of ELP. During 1-month follow-up, with capsular contraction and healing, the IOL position moved slightly forward, hyperopia degree decreased significantly, and corrected visual acuity reached 0.7.
Conclusion   Early hyperopic shift after cataract surgery is mainly caused by posterior displacement of IOL effective position. The supporting property of IOL haptic material and capsular healing status are key influencing factors. AS-OCT can non-invasively and dynamically monitor ELP changes, providing reliable evidence for diagnosis and management. Emphasizing preoperative evaluation, rational selection of IOL and standardized intraoperative operation can reduce postoperative refractive shift and improve visual quality and surgical safety.