目的：观察两种不同手术方法治疗不同程度的晶状体不全脱位合并白内障的临床效果。

方法：前瞻性观察性研究。研究纳入2021年5月1日至2024年4月30日期间在榆林市中医医院就诊的晶状体不全脱位合并白内障患者。根据悬韧带异常或损伤范围确定手术方式。悬韧带异常或损伤范围≤6个钟点且超声乳化完成后，囊袋完整、稳定性好，悬韧带损伤范围没有加重，采用超声乳化晶状体吸除联合囊袋张力环+IOL植入三联手术方式(张力环组)； 悬韧带异常或损伤范围>6-9个钟点位或术中因晶状体囊袋稳定性差，悬韧带损伤范围加重采用超声乳化晶状体吸除+IOL缝线囊内固定术(缝线组)。分别于术后不同时间记录所有患者视力(LogMAR)、等效球镜、眼压、角膜内皮细胞计数、前房深度以及并发症。

结果：本研究共40例40眼纳入最终数据分析，其中张力环组21例21眼(年龄60.62±1.65岁，男15例，女6例)，缝线组19例19眼(年龄64.26±1.69岁，男15例，女4例)。张力环组悬韧带损伤范围中位数4.0(2.75，5.25)个钟点位，缝线组为7.0(6.5，8.0)个钟点位(P<0.001)，其余基本资料两组间无显著差异。两组患者术后1 mo视力均明显提高，张力环组较术前提高0.72±0.45(t=5.44，P<0.001)，缝线组较术前提高1.11±1.01(t=4.09，P=0.001)，术后12 mo两组间视力比较无差异(t=0.24，P=0.81)。两组患者术后1、12 mo等效球镜比较无差异(均P>0.05)。术后1 mo缝线组角膜内皮细胞计数明显低于张力环组(t=3.75，P=0.001)。张力环组术后6 mo IOL水平倾斜度为3.06°±1.47°，IOL水平偏心量0.25±0.10 mm，均明显小于缝线组(均P<0.001)。两组总并发症发生率无差异(23.8% vs 36.8%， χ²=0.807，P=0.369)。

结论：对于悬韧带异常或损伤范围≤6个钟点且超声乳化完成后，囊袋完整、稳定性好，采用超声乳化晶状体吸除联合囊袋张力环+IOL植入三联手术方式，而悬韧带异常或损伤范围>6-9个钟点或术中囊袋稳定性差、悬韧带损伤范围加重，采用超声乳化晶状体吸除+IOL缝线囊内固定术，均可获得良好的术后效果。全面的术前和术中评估有助于确定合适的手术方式。

METHODS: Prospective observational study. Patients with lens subluxation and cataracts who were treated in Yulin Hospital of Traditional Chinese Medicine from May 1, 2021 to April 30, 2024 were included. The surgical method was determined according to the range of zonular abnormalities or injuries. If the zonular abnormality or injury range was ≤6 clock hours and the capsular bag was intact and stable with no aggravation of the zonular injury after completion of phacoemulsification, the triple procedure of phacoemulsification combined with capsular tension ring(CTR)implantation plus intraocular lens(IOL)implantation was adopted(CTR group); if the zonular abnormality or injury range is >6-9 clock hours, or if the stability of the lens capsular bag was poor and the zonular injury range was aggravated intraoperatively, phacoemulsification combined with scleral-sutured intracapsular IOL fixation was performed(Suture group). Visual acuity(LogMAR), spherical equivalent, intraocular pressure, corneal endothelial cell count, anterior chamber depth and complications of all patients were recorded at different time points after surgery, respectively.

RESULTS: A total of 40 cases(40 eyes)were included in study, including 21 cases(21 eyes)in CTR group(age 60.62±1.65 y, 15 males and 6 females)and 19 cases(19 eyes)in Suture group(age 64.26±1.69 y, 15 males and 4 females).The median range of zonular injury in the CTR group was 4.0(2.75, 5.25)clock hours, while that in the Suture group was 7.0(6.5, 8.0)clock hours(P<0.001), and there were no significant differences in other basic data between the two groups. The visual acuity of patients in both groups significantly improved one month after surgery. The CTR group showed an improvement of 0.72±0.45 logMAR compared with preoperative values(t=5.44, P<0.001), and the Suture group showed an improvement of 1.11±1.01 LogMAR compared with preoperative values(t=4.09, P=0.001). There was no significant difference in visual acuity between the two groups 12 mo after surgery(t=0.24, P=0.81). There was no significant difference in the spherical equivalent between the two groups at 1, 12 mo after surgery(both P>0.05). The corneal endothelial cell count in the Suture group was significantly lower than that in CTR group after surgery(t=3.75, P=0.001). In the CTR group, at postoperative 6 mo, IOL horizontal tilt was 3.06°±1.47°, and the IOL horizontal decentration was 0.25±0.10 mm, both of which were significantly lower than those in the Suture group(both P<0.001). There was no significant difference in the total incidence of complications between the two groups(23.8% vs 36.8%, χ²=0.807, P=0.369).

CONCLUSION:For cases with zonular abnormalities or injury involving ≤6 clock hours, where the capsular bag remains intact and stable after phacoemulsification, the triple procedure of phacoemulsification combined with CTR implantation and IOL implantation is adopted. In cases with zonular abnormalities or injury involving >6-9 clock hours, or when intraoperative capsular bag stability is poor and zonular injury worsens, phacoemulsification combined with scleral-sutured intracapusular IOL fixation is performed. Both approaches can achieve favorable postoperative outcomes. Comprehensive preoperative and intraoperative evaluations help determine the appropriate surgical method.