近年来，晶状体脱位逐渐引起眼科医生的重视，针对晶状体脱位手术的探索与改进一直在持续进行中。随着超声乳化技术的发明和眼内植入材料的改进，晶状体脱位患者人工晶状体(intraocular lens,IOL)的植入和固定成为眼科医生关注的焦点。IOL悬吊术作为治疗严重晶状体脱位以及无晶状体眼且囊袋支撑不足或无囊袋患者的IOL植入的经典术式，主要经历了传统的经巩膜后房型IOL缝线固定术、以Z字形缝合为代表的无线结后房型IOL缝线固定术和无缝线的IOL巩膜层间固定术三个阶段，理解并掌握各种IOL悬吊术的优势和局限性对提高眼科医生的诊疗水平、改善患者的预后具有重要意义。

In recent years, ectopia lentis has gradually attracted the attention of ophthalmologists, and the exploration and improvement of surgery for ectopia lentis has been in progress. With the invention of phacoemulsification technology and the improvement of intraocular implant materials, the implantation and fixation of intraocular lens (IOL) in patients with ectopia lentis has become the focus of ophthalmologists. Suspensory IOL implantation is a classic operation for IOL implantation in patients with severe lens dislocation or aphakia with insufficient capsular bag support. It has mainly gone through three stages: traditional trans-sclera suture-fixed posterior chamber IOL, kontless posterior chamber IOL fixation represented by Z suture, and sutureless intrascleral IOL fixation. Understanding and mastering the advantages and limitations of various IOL fixation methods is of great importance for improving the diagnosis and treatment level of ophthalmologists and as well as the prognosis of patients.

目的：通过对改良“Z”形无线结经巩膜缝线固定人工晶状体手术和传统有线结巩膜缝线固定人工晶状体手术治疗先天性晶状体脱位的比较来评价改良术式的临床疗效。方法：回顾性病例研究。纳入2018年1月—2021年3月期间于中山大学中山眼科中心行手术治疗的先天性晶状体脱位患者73例73眼，按手术方式不同将患者分为无线结组36例36眼和有线结组37例37眼。比较两组患者术前和术后1年的球镜度(DS)、柱镜度(DC)、等效球镜(SE)、最佳矫正视力(BCVA)、眼压(IOP)、眼轴长度(AL)、角膜内皮细胞计数和术后并发症的发生率。结果：两组患者术前各项观察指标组间比较差异无统计学意义(均P>0.05)。两组患者术后1年 BCVA 均较术前提高(均P<0.05)，SE均较术前降低(均P<0.05)。两组患者术后1年 BCVA 、DS、DC、SE、IOP、AL、角膜内皮细胞丢失率组间比较差异均无统计学意义(均P>0.05)。术后1年，有线结组有5例(13.5%)出现缝线暴露，无线结组未出现缝线暴露，组间比较差异有统计学意义(P<0.05)。结论：改良无线结 IOL 巩膜缝线固定手术可改善CEL患者的最佳矫正视力和屈光不正，有效减少缝线暴露及相关并发症。

Objective: To evaluate the clinical efficacy of modified “Z”-shaped knotless transscleral suture fixation intraocular lens (IOL) and traditional knotted transscleral suture fixation IOL in congenital ectopia lentis. Methods: A retrospective case study. A total of 73 eyes of 73 patients with congenital ectopia lentis who underwent surgical treatment in our hospital from January 2018 to March 2021 were included. According to different surgical methods, the patients were divided into the knotless group (36 eyes) and knotted group (37 eyes). Preoperative and postoperative of 1-year diopter sphere (DS), diopter cylinder (DC), spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL), corneal endothelial cell counts and the occurrence of postoperative complications rate were analyzed among two groups. Results: There was no significant difference in preoperative outcome measures between the two groups (P>0.05). BCVA at 1-year postoperative was significantly better (P<0.05), and SE at 1-year postoperative was significantly lower (P<0.05). There was no significant difference in BCVA, DS, DC, SE, IOP, AL, and corneal endothelial cell loss rate between the two groups at 1-year after operation (P>0.05). One year after the operation, there were 5 cases of suture exposure (13.5%) in the knotted group and no suture exposure in the knotless group, and the difference was statistically significant (P<0.05). Conclusions: The modified knotless IOL transscleral suture fixation can improve the best corrected visual acuity and alleviate ametropia of CEL patients, and reduce suture exposure and related complications effectively.

目的：探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocular lens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法：采用回顾性分析，选取2019年1月至 2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼)，随机分为两组，纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼)，观察两组术后最佳矫正视力及并发症等情况。结果：两组术后最佳矫正视力比术前均有改善(P<0.001)，而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组，2眼(10.00%)需要重复激光治疗，1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论：SCSF-IOL是治疗球形晶状体的简单易行的手术方式，疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。

Objective: To investigate the efficacy and safety of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens (IOL) implantation in the treatment of microspherophakia (MSP). Methods: by retrospective analysis, 37 MSP patients (37 eyes) who were treated in our hospital from January 2019 to June 2020 were randomly divided into two groups, including 20 MSP patients (20 eyes) who treated by SCSF-IOL and 17 MSP patients (17 eyes) who treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL). The best corrected vision and complications were observed. Results: the best corrected vision was significantly improved in both groups (P < 0.001), but there was no remarkable difference between the two groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd: YAG laser posterior capsulotomy was performed from 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment, and one eye (5.00%) had a decentered capsule opening. Posterior capsular opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up. Conclusions: SCSF-IOL is a simple and viable surgical option for managing MSP and is comparable with the MCTR-IOL. Nd: YAG laser posterior capsulotomy is a necessary mean to prevent residual capsule complications after the SCSF-IOL procedure.

先天性晶状体不全脱位是一种较为罕见的晶状体悬韧带异常的疾病，其手术治疗极具挑战性。以人工晶状体悬吊为代表的传统手术方式易出现囊袋破裂、玻璃体疝、人工晶状体脱位和继发性青光眼等严重并发症。近年来，以重建囊袋悬韧带隔为目标，新型囊袋辅助装置的应用极大程度提高了先天性晶状体不全脱位的手术成功率。然而，以改良式张力环为代表的囊袋辅助装置在我国仍难以得到普及且操作繁琐。因此，如何最大程度利用普通张力环等最常见的装备，设计出一种安全可靠手治疗先天性晶状体不全脱位的手术方式是眼科界亟待解决的问题。本文将介绍一种二期张力环缝合固定治疗先天性晶状体不全脱位手术技术。该技术仅需使用普通张力环，具有操作简单安全、术后效果稳定和易于技术推广的优点。

Congenital ectopia lentis is a relatively rare zonular disorder of the lens, and its surgical treatment is extremely challenging. The traditional surgical procedures represented by intraocular lens suspension are prone to result in serious complications such as capsular bag rupture, vitreous hernia, intraocular lens dislocation and secondary glaucoma. In recent years, with the goal of reconstructing the capsular bag–zonules diaphragm, the application of new capsular bag-assisted devices has greatly improved the surgical success rate of congenital ectopia lentis. However, the capsular-assisted devices, such as modified capsular tension ring, are still difficult to be popularized in China and the surgical procedures are complicated. Therefore, how to maximize the use of common equipment such as normal capsular tension rings and design a safe and reliable surgical method for the treatment of congenital ectopia lentis is an urgent issue for ophthalmologists. This article aims to introduce a two-stage capsular tension ring fixation for the treatment of congenital ectopia lentis, which has many advantages such as simple and safe operation, stable postoperative effect and less requirements for special equipment, and is worth promoting in clinical practice.

目的：探讨人工晶状体(IOL)预先巩膜悬吊在严重晶状体半脱位中的应用效果。方法：选取 2018年12月至2022年7月四川省人民医院收治的>180°的严重晶状体半脱位患者8例(8 眼)。术中避开脱位的晶状体，预先将IOL悬吊于玻璃体腔，再将晶状体托起置于IOL上方，必要时辅助以虹膜拉钩，稳定晶状体，确保超声乳化手术安全完成。结果：严重的晶状体半脱位患者8例，其中晶状体核N1-N3硬度的患者各1例，单独使用IOL预先巩膜悬吊于术中稳定脱位的晶状体，3例超声乳化手术均顺利完成；达N4患者3例、N5患者2例，其中4例在虹膜拉钩的辅助下安全完成超声乳化；有1例N5的患者，由于悬韧带损伤超过270°，在将晶状体托起放置于IOL之上时，坠入玻璃体腔，给予玻璃体腔超声粉碎处理。8例患者术后IOL均居中，视力有不同程度的提高，眼压正常，未见严重并发症。结论：在严重晶状体半脱位的超声乳化手术中，对于N2~N3的软核，IOL预先巩膜悬吊可以良好地稳定晶状体，确保超声乳化手术的顺利进行；对于N4~N5的硬核，IOL预先巩膜悬吊可以作为一种辅助方法，联合虹膜拉钩共同稳定晶状体，确保超声乳化手术的安全进行。

Objective: To investigate the effect of intraocular lens (IOL) pre-suspension in thetreatment of severe lens subluxation. Methods: Retrospective case study. From December 2018 to July 2022, 8 eyes of 8 patients with severe lens subluxation greater than 180 degrees admitted to our hospital were selected. During surgery, the IOL should avoid the subluxated lens and be pre-suspended in the vitreous cavity, and then the lens is lifted and placed above the IOL. If necessary, the iris hook can be used to stabilize the lens to ensure the safe completion of phacoemulsification. Results: There were 8 patients with severe subluxation of lens. Among them, the hardness of 3 patients' lens nucleus ranged from N1 to N3. In these 3 patients, we used the IOL pre-suspension alone to stabilize the subluxated lens, and phacoemulsification in these 3 patients was successfully completed. Three patients had N4 and 2 patients had N5, of which 4 patients underwent phacoemulsification safely with the assistance of iris hook. In another patient with N5, the lens fell into the vitreous cavity during surgery (the suspension ligament rapture greater than 270 degrees) when it was lifted and placed on the IOL which was crushed by the vitreous cavity ultrasound. After surgery, the IOL was centered in all 8 patients, visual acuity was improved to varying degrees, intraocular pressure was normal, and no serious complications were observed. Conclusions: In severe lens subluxation surgery, IOL presuspension in soft nuclei of N2 to N3 can stabilize the lens well and ensure the safety of phacoemulsification. For hard nuclei N4 to N5, IOL presuspension can be used as an auxiliary method in combination with iris hook to stabilize the lens and ensure the safety of phacoemulsification.

YAMANE式后房型人工晶状体巩膜层间固定术是近年出现的一种人工晶状体悬吊术式。该文介绍了笔者结合实际条件对其改良后的手术步骤，手术关键点及使用经验。在缺乏足够囊膜支撑的条件下，此手术方式微创、安全、有效，术后恢复快。在随访期间(最长5年)，视力稳定，未出现人工晶状体脱位、移位、倾斜，人工晶状体夹持及人工晶状体襻暴露等并发症，值得临床推广应用。

The YAMANE intrascleral fixation of posterior chamber intraocular lens (IOL) is a new technique in recent five years for IOL suspension. This article introduces a modified YAMANE technique including surgical procedure, key points and using experience. In the absence of adequate capsular support, this procedure is minimally invasive, safe, effective and has a fast postoperative recovery. During the follow-up period (up to 5 years), the visual acuity was stable, and there were no complications such as luxation of lens, displacement, tilt of intraocular lens, intraocular lens clamping and IOL haptic exposure.

玻璃体视网膜疾病并发白内障患者行玻璃体切割术联合超声乳化白内障摘除术，即前后节联合手术，是高效的手术方式，而后囊膜破裂(posterior capsular rupture,PCR)是超声乳化白内障摘除术的术中并发症之一，能够及时、有效地处理PCR，稳定、安全地植入人工晶状体(intraocular lens,IOL)，对于顺利完成后段手术，减少术后并发症十分重要。本文将对前后段联合手术中后囊膜破裂的术中处理、以及IOL光学部夹持固定法植入IOL的手术技术要点进行总结。

Combined surgery of pars plana vitrectomy (PPV) and phacoemulsification is an effective and safe way for management of retinal diseases complicated with cataract. Posterior capsular rupture (PCR) is one of the common intraoperative complications of phacoemulsification, and it is thus very important to deal with it promptly and efficiently, and ensure the subsequent procedures of intraocular lens (IOL) implantation as well as PPV. We will summarize the key points of the surgical technique for management of PCR and capture of IOL optic during combined surgery.

目的：探讨一种改良的简便的儿童晶状体不全脱位摘除技术的手术方法及临床效果。方法：对23例(40眼)晶状体不全脱位儿童采用改良手术方法进行脱位晶状体摘除，术中先做巩膜隧道切口，3个角膜缘穿刺口，经穿刺口放置前房维持器，在维持前房灌注下，截囊针撕囊，水分离后抽吸针头吸净晶状体内容物。撤去前房维持器，用撕囊镊和线镊将囊袋从主切口拖出。若有玻璃体脱出则行前部玻璃体切除术，然后行人工晶状体巩膜缝线固定术。术后中位随访39.0个月，观察其手术效果。结果：术后患儿平均裸眼视力为(0.44±0.22)LogMAR，平均最佳矫正视力为(0.20±0.16)LogMAR，较术前均显著提高(P<0.001)。所有患儿术中眼内压稳定，术中术后没有继发视网膜脱离、脉络膜上腔出血等眼底并发症的发生。结论：改良的儿童晶状体不全脱位摘除技术具有对玻璃体扰动少、手术时间较短、简便易学、对手术设备要求低的优点，值得临床推广。

Objective: To investigate the operation method and clinical effects of a modified-simple technique in children with subluxated lens extraction. Methods: Lens extraction was performed in 40 eyes of 23 children. During operation, the scleral tunnel and 3 lateral corneal incision were made, and anterior chamber maintainer was inserted through one corneal incision. Under stable anterior chamber perfusion, anterior capsulorrhexis was made by needle capsulotome. After hydro-dissection, the content of lens was withdrawn by suction needle completely. Then anterior chamber maintainer was removed, and the capsular bag was dragged out by capsulorhexis forceps and fixation forceps. Anterior vitrectomy was performed if there was prolapse of vitreous. Then scleral intraocular lens fixation was performed. The surgical effects were observed at median 39.0 months postoperative. Results: After surgery, the average uncorrected visual acuity was (0.44±0.22) LogMAR, the average best corrected distant visual acuity was (0.20±0.16) LogMAR. The uncorrected visual acuity and best corrected distant visual acuity were improved postoperative(P<0.001). The intraocular pressure of all patients was stable during operation. During and after operation, there were no fundus complications, such as secondary retinal detachment and suprachoroidal hemorrhage. Conclusion: Modified-simple technique of subluxated lens extraction of children has little disturbance on vitreous and takes shorter time of operation. It is simple, easy to learn and requires simple surgical equipment. This modified technique deserves to be generalized.

晶状体脱位是临床上常见的疾病，也是晶状体手术中的难点。笔者从既往研究中得到启发，在充分论证了可行性与安全性后原创性地提出了植入性囊袋拉钩技术。经过临床应用与随访，发现该技术的临床效果较为理想，可以最大可能地保留完整的晶状体囊袋，实现人工晶状体的囊内植入，同时笔者也对其设计与操作方法进行了改良。该文就植入性囊袋拉钩的设计、原理、可行性、适应症以及操作细节等进行详细介绍。

Crystalline lens dislocation is a commonly encountered clinical condition that remains challenging in the realm of lens surgery. Inspired by prior studies, the authors originally proposed a technique involving implantable polypropylene capsular hooks after demonstrating their feasibility and safety. After six years of clinical application and follow-up, the technique has shown capable of helping preserve the complete lens capsule to a maximally viable extent and achieve intracapsular implantation of an intraocular lens with high efficacy. At the same time, the authors have also improved the technique’s design and operational method. This paper comprehensively disseminates lessons learned on the principle, design, feasibility, indications, and procedural details of the implantable polypropylene capsular hook technique.

晶状体悬韧带异常（包括松弛和断裂）可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高，即闭角型青光眼（angle closure glaucoma，ACG）的发生。特发性悬韧带异常多发生于原发性闭角型青光眼（primary angle closure glaucoma，PACG），可能是PACG的发病机制之一，但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等，虹膜/晶状体震颤等体征及超声生物显微镜（ultrasound biomicroscopy, UBM）检查能够诊断的悬韧带异常比例较低，通常在青光眼白内障联合手术前未能被诊断而在术中被发现，故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部，连续环形撕囊破囊时可见前囊放射状皱褶，超声乳化时囊袋赤道部移位或卷曲，灌注抽吸时囊袋异常飘动，囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围，选择超声乳化晶状体吸除联合人工晶体植入，联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常，制定个体化治疗方案，以保证手术安全和疗效。

Zonulopathy (including zonular laxity and dehiscence) can cause anterior displacement of iris-lens diaphragm, shallow anterior chamber, anterior chamber angle closure and elevated intraocular pressure, resulting in angle closure glaucoma (ACG). Idiopathic zonulopathy is common in primary angle closure glaucoma (PACG), which may be one of the pathogenic mechanisms of PACG. But further prospective cohort studies are needed to verify that. ?e proportion of diagnosis ofzonulopathy in PACG patients before cataract extraction in combination with anti-glaucoma surgery is low by signs of anterior chamber depth differences between both eyes, iridodonesis / phacodonesis and UBM examination. Hence, most cases with zonulopathy in PACG are found during the operation, which is called occult zonulopathy. At present, the diagnosis of zonulopathy in PACG is often made according to the intraoperative manifestations, such as visible capsular equator aěer mydriasis, wrinkling of the anterior capsule during manual capsulorhexis, infolding of peripheral capsule or visualization of the capsular equator during the cortical or nuclear removal; loose or ěoppy capsular bag. According to different ranges and severities ofzonulopathy, phacoemulsi?cation combined with intraocular lens (IOL) implantation, with or without capsule tension ring implantation, or sclera-fixated IOL is selected. PACG patients should be paid more attention to the diagnosis and differentiation ofzonulopathy before and during operation, fully improved the preoperative examination, and formulated individualized treatment plans to ensure the safety and efficacy of operation.

临床上囊袋张力环(capsular tension ring,CTR)与睫状体接触导致的反复持续性高眼压较为少见，本文报告一例改良型CTR植入术后反复持续性高眼压的病例，行“巩膜悬吊线松解术”后高眼压状态有效缓解，考虑可能与巩膜固定缝线过紧，造成改良型CTR局部与睫状体相接触，刺激睫状体分泌过量房水有关。

Recurrent intraocular hypertension caused by contact between capsular tension ring (CTR) and ciliary body is rare clinically. We report a case of recurrent intraocular hy pertension after modified CTR implantation. The IOP returned to normal levels when released the scleral suture. We speculated that the ciliary process irritated by MCTR might increase aqueous humor secretion because of a tight scleral suture.

球形晶状体是一种罕见的先天性晶状体悬韧带疾病，表现为晶状体前后径增加，赤道半径减小，类似球形。临床特点包括浅前房、晶状体源性高度近视、晶状体脱位及继发青光眼等。治疗上早期可以通过验光配镜提高视力，当继发晶状体脱位及青光眼时需尽早进行手术治疗。本例报道一例72岁男性患者，因右眼视力下降2年入院。既往近视，近视逐渐加深，近2年患者双眼配镜-10D，视力无明显改善。就诊后考虑球形晶状体所致晶状体不全脱位合并白内障，入院后行囊袋拉钩固定下白内障超声乳化+人工晶状体悬吊+前段玻璃体切除术。患者术后1个月后复诊，发现黄斑水肿，予以复方平地木颗粒口服，溴芬酸钠滴眼液滴眼。2周后复诊视力及黄斑水肿明显好转。

Microspherophakia (MSP) is a rare congenital zonular dysplasia characterized by increased anteroposterior lens thickness and reduced equatorial diameter, resembling a spherical shape. The related ocular manifestations of MSP include shallow anterior chamber, lens derived high myopia, ectopia lentis and secondary glaucoma. In the early stage of MSP, vision acuity may be improved by glasses. Cataract surgery is necessary once secondary lens dislocation and glaucoma occur. A 72-year-old male hospitalized patient was reported who complained increased blurred vision of his right eye for 2 years. In the past 2 years, the power of his binocular glasses was increased to -10 diopters without significant improvement in visual acuity. Lens dislocation and phakic insufficiency caused by MSP was diagnosed after he attending clinics at the Eye and ENT Hospital of Fudan University, Shanghai, China. Phacoemulsification with scleral sutured intraocular lens (IOL) implantation surgery and anterior vitrectomy were performed. One month after operation, macular edema was found at first follow-up. Compound pingdingmu granule was taken orally and Bromfenac sodium eye drops were applied three times a day. Two weeks later, visual acuity of his right eye was improved significantly and macular edema was eliminated dramatically.

晶状体脱位是指由于各种病因引起的悬韧带发育异常及断裂，从而导致晶状体的位置异常。晶状体脱位的类型复杂，临床处理也各不相同。本文报道了一名老年男性，因外伤分别致右眼晶状体全脱位，左眼人工晶状体不全脱位，伴高同型半胱氨酸血症，在入院后行双眼手术，术式不一，但都获得了预期效果。

Ectopai lentis refers to the abnormal development and rupture of the suspensory ligament caused by various causes, which leads to the abnormal position of the lens. The types of lens dislocation are complex and the clinical treatment methods are different. This article reports an elderly man who suffered from complete dislocation of the right eye lens and incomplete dislocation of the left eye intraocular lens in the left eye, respectively, accompanied by hyperhomocysteinemia due to trauma. After admission, he underwent binocular surgery after admission, and the surgical methods were different, but the expected results were obtained.

马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病，约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者，因患有MFS致双眼晶状体半脱位伴双眼并发性白内障，先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术，术后保留低度近视，随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。

Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.