目的：观察四环单结瞳孔成形术在青光眼白内障联合手术中的应用效果。

方法：收集2015-08/2018-03我院青光眼急性发作后大瞳孔且合并有白内障的患者28例30眼。所有患者均行白内障超声乳化吸除与人工晶状体植入，联合房角分离或小梁切除术及四环单结瞳孔成形术治疗。观察术前及术后7d的矫正视力、瞳孔直径、术中及术后并发症，并进行术前和术后3mo的视觉质量调查。

结果：术后7d矫正视力较术前有明显提高，且术后无复视、眩光等视觉不良反应。术前瞳孔直径5.9±0.25mm，术后7d为4.1±0.13mm(P<0.05)。术后3mo视觉质量较术前有较大提高(P<0.05)。术中并发症：有5例5眼缝合出现虹膜分层撕脱，1例1眼成形瞳孔旁出现小裂孔，3例3眼虹膜根部少量渗血，经相应处理后均恢复良好。术后早期并发症以前房炎症反应常见，抗炎治疗后炎症吸收。长期观察未见瞳孔区线结松动、脱落。

结论：四环单结瞳孔成形术操作简单、安全、有效，能明显消除因青光眼急性发作后由大瞳孔引起的复视、眩光等视觉障碍。

METHODS: Twenty eight patients(30 eyes)suffered from acute attack of glaucoma with large pupil and cataract, received cataract phacoemulsification and intraocular lens implantation combined with angle separation or trabeculectomy and single-pass four-throw pupilloplasty in apllication. Preoperative and postoperative visual acuity, pupil diameter and complications were observed, and postoperative visual quality were measured.

RESULTS: The visual acuity of 7d after operation was significantly improved without double vision and glare. The preoperative pupil diameter was 5.9+0.25mm, and the postoperative was 4.1±0.13mm(P<0.05). Postoperative visual quality was significantly improved(P<0.05). Among the intraoperative complications, there were 5 cases 5 eyes of iridodelamination avulsion after suture, 1 case 1 eye of small holes near the formed pupil and 3 cases 3 eyes of small blood seepage at the iris root, which recovered well after the corresponding treatment. The inflammation of anterior chamber were common at the early postoperative period, and inflammatory absorption after anti-inflammatory treatment. Long-term observation showed no loosening or shedding of the line knot in the pupil area.

CONCLUSION: Single-pass four-throw pupilloplasty is simple, safe and effective. It can obviously eliminate the visual impairment caused by the large pupil after acute glaucoma attack.