植入不同尺寸囊袋张力环对合并悬韧带松弛急性闭角型青光眼患者术后疗效的影响

目的　探讨植入不同尺寸囊袋张力环（CTR）对合并悬韧带松弛急性闭角型青光眼（AACG）患者术后疗效的影响。方法　该研究为前瞻性研究。选取2018年1月至12月就诊于潍坊眼科医院的合并悬韧带松弛AACG患者34例（40眼），所有患者均行超声乳化白内障吸出联合人工晶状体植入+房角分离手术。随机选取20眼植入大尺寸CTR（13 mm×11 mm），作为大尺寸组；20眼植入小尺寸CTR（12 mm×10 mm），作为小尺寸组。术后观察各组患者最佳矫正视力、眼压、有效晶状体位置（人工晶状体倾斜度和偏中心距离）、CTR直径、后囊膜平整程度、撕囊口形状以及是否发生后发性白内障等。结果　术前和术后3个月两组患者最佳矫正视力差异均无统计学意义（均为P>0.05）；两组患者术后3个月最佳矫正视力均高于术前，差异均有统计学意义（均为P<0.05）。术前和术后3个月两组患者眼压差异均无统计学意义（均为P>0.05）；两组患者术后3个月眼压均低于术前，差异均有统计学意义（均为P<0.05）。随访期间两组患者均未见眼压明显波动。两组患者术后3个月37眼人工晶状体均保持正位，小尺寸组3眼发生轻度人工晶状体偏位。术后1个月及3个月大尺寸组人工晶状体偏中心距离及倾斜度均小于小尺寸组，差异均有统计学意义（均为P<0.05）。两组患者术中CTR两端睫状突数量和术后3个月CTR直径均与眼轴长度和白到白距离呈显著正相关（均为P<0.05）。小尺寸组长眼轴患者CTR直径大于短眼轴患者，差异有统计学意义（P<0.05）。两组患者均顺利植入人工晶状体和CTR，术中无并发症发生。术后观察无明显角膜水肿、葡萄膜炎等并发症。术后3个月随访发现2眼（大尺寸组、小尺寸组各1眼）有轻度后囊膜混浊。术后3个月小尺寸组9眼出现后囊膜皱褶，其中3眼发生撕囊口形状改变。结论　超声乳化白内障吸出联合人工晶状体植入+房角分离手术植入CTR对合并悬韧带松弛AACG患者治疗效果较好，眼轴长度和白到白距离可以作为选择不同尺寸的CTR的参考依据，眼轴较长（大于23.00 mm）选择相对较大尺寸CTR，对人工晶状体-囊袋复合体有较好的稳定作用。

Different size capsular tension ring implantation treatment for acute angle-closure glaucoma with zounle relaxation

Objective　To investigate the clinical efficacy and the effect of intraocular lens（IOL）-capsular complex of different size capsular tension ring（CTR）implantation on acute angle-closure glaucoma（AACG）with zounle relaxation.Methods　A prospective randomized case series study. From January to December 2018, 34 patients（40 eyes）of AACG with zounle relaxation were treated in Weifang Eye Hospital. All patients underwent phacoemulsification（Phaco）and IOL implantation with CTR implantation, combined with goniosynechialysis surgery, and they were randomized with two groups, of which 20 eyes in large size group were implanted with CTR（13 mm×11 mm）, and 20 eyes in small size group were implanted with CTR（12 mm×10 mm）. The postoperative best corrected visual acuity, intraocular pressure, the position of the IOL (IOL tilt and off-center distance), the diameter of CTR were observed, and the posterior capsular flatness, shape of the capsulotomy, posterior capsular opacification were also observed.Results　There were no significant difference in the best corrected visual acuity in two groups of 3 months postoperatively（both P>0.05）. The best corrected visual acuity of the two groups of patients at 3 months after operation was higher than that before operation, and the difference was statistically significant (both P<0.05). There was no significant difference in intraocular pressure between the two groups of patients before and 3 months after the operation (both P>0.05). The intraocular pressure of the two groups of patients 3 months after operation was lower than that before preoperation, and the difference was statistically significant (both P<0.05). There was no significant fluctuation in intraocular pressure during follow-up. At 3 months postoperatively, 37 eyes of the IOL were in good position, and 3 eyes of group small size had IOL deviation. The eccentric distance and inclination of the IOL in the large size group were smaller than those in the small size group 1 month and 3 months after surgery, and the differences were statistically significant (both P<0.05). The number of ciliary processes after viscoelasticity aspiration at both ends of the CTR, and the diameter of CTR were both positively related to the axial length and white-to-white distance in two groups（all P<0.05）. The CTR diameter of the long axis patients in the small size group was larger than that of the short axis patients, and the difference was statistically significant (P<0.05). Both groups of patients were successfully implanted with IOL and CTR without complications during the operation. No obvious corneal edema, uveitis and other complications were observed after operation. In the follow-up for 3 months, 2 eyes (1 eye in the large size group and the other eye in the small size group) had mild posterior capsule opacity. In small size group, 9 eyes developed posterior capsular fold, among which 3 eyes suffered from the shape of capsulorhexis.Conclusion　Phaco combined with CTR implantation has a better therapeutic effect on AACG patients with zounlar relaxation. The axial length and white-to-white distance can provide reference for selecting different sizes of CTR. If the eye axis is longer (more than 23 mm), choosing a relatively large size CTR has a good stabilizing effect on the IOL-capsular complex.