目的：探讨两种经巩膜缝线固定法治疗人工晶状体（ intraocular lens，IOL）-囊袋复合物半脱位的方法及效果。方法：回顾性研究2014 年 6 月至 2017 年 12 月 IOL -囊袋复合物半脱位共计 31 例，36 眼。详细检查后分类处理。A 组为更换 IOL 组：对术中未植入囊袋张力环或术后发生脱位时间超过 1 年者，取出原 IOL 并重新行缝襻固定术。B 组为重新固定组：首次 IOL 植入术中植入了囊袋张力环且术后发生脱位时间不超过 1 年者，行囊袋张力环及 IOL 袢缝合固定。A 组 25 只眼，B 组 11 只眼。观察术中、术后并发症情况，术后 1 d 、 1 周、 3 个月的最佳矫正视力，并使用 Image-ProPlus v6.0 软件测量 IOL 偏心情况。结果：患者术后视力均较术前提高，术后 3 个月最佳矫正视力提高者 32 眼（91.7%），不变者 3 眼（8.3%）。术后 1 d ，两组术后视力分布差异有统计学意义；在术后 1 周、术后 3 个月，差异无统计学意义。两组术中未见视网膜脱离等严重并发症。A 组术后一过性眼压高 2 例，玻璃体积血 2 例，经保守治疗恢复。术前图像分析软件测量 IOL 偏心均大于 2 mm ，术后 3 个月 IOL 偏心小于 0.5 mm 者 4 眼（11.1%），偏心 0.5 ~ 1 mm 者 21 眼（58.3%），偏心 1 ~ 2 mm 者 11 眼（30.6%）。两组术后 3 个月 IOL 偏心差异无统计学意义。结论：根据 IOL 半脱位情况来选择不同的经巩膜缝线固定法较为安全有效。采用直接经睫状沟缝线固定复位 IOL 方法的患者术后视力恢复更快。

Objective: To investigate two methods and outcomes of transscleral sutured treatment of the intraocular lens (IOL)-capsular complex dislocation. Methods: A total of 31 cases (36 eyes) of IOL-capsular complex dislocation were studied retrospectively from June 2014 to December 2017. In group A, IOL replacement was performed. New IOL was sutured through the sulcus and the sclera after the original IOL was extracted when the capsular tension ring had not been implanted during the operation, or IOL dislocation happened at least 1 year postoperatively. In group B, IOL refixation was conducted. The original IOL was repositioned directly via transscleral suturing when the capsular tension ring was implanted, and the postoperative dislocation occurred less than 1 year after surgery. There were 25 eyes in group A and 11 eyes in group B. Intra- and post-operative complications were observed. Best corrected visual acuity (BCVA) was analyzed 1 d, 1 week, and 3 months after surgery. IOL decentration was measured using Image-ProPlus v6.0 software. Results: All patients had better visual acuity after the surgery. BCVA was improved in 32 eyes (91.7%), and remained unchanged in 3 eyes (8.3%) at postoperative 3 months. The difference of vision distribution between the two groups was statistically significant 1 d after surgery, and there was no statistical significance between two groups at postoperative 1 week and 3 months. No retinal detachment and other serious complications were observed. In group A, temporary increase in intraocular pressure was noted in 3 eyes and mild vitreous hemorrhage was observed in 2 eyes, which were effectively recovered after medical treatment. The imaging analysis revealed more than 2 mm IOL eccentricity was observed in all cases preoperatively. Postoperative IOL eccentricity were less than 0.5 mm in 4 eyes (11.1%), 0.5 - 1 mm in 21 eyes (58.3%), and 1-2 mm in 11 eyes (30.6%). There was no statistical significance in IOL eccentricity between two groups at 3 months after surgery.  Conclusion: It is safe and effective to choose different scleral suture fixation methods according to IOL-capsular bag dislocation. The visual acuity of patients is faster recovered after IOL fixation via ciliary sulcus suture compared with other approaches.

目的：观察依镜有晶状体眼后房屈光晶体(phakic refractive lens,PRL)植入术矫正超高度近视的疗效和安全性。方法：纳入自2018年1月—2020年9月在深圳市眼科医院行依镜PRL植入术的超高度近视患者共24例39眼，进行自身对照研究。其中，男8例13眼，女16例26眼，平均年龄(31.15±6.33)岁。观察术后屈光度、视力[裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)]、眼压、角膜内皮细胞计数、拱高、手术并发症等指标。结果：中位随访时间为5.5(3.0，11.0)月。屈光度从术前(?22.29±4.96) D降低至术后(?0.28±1.01) D(t=24.421，P<0.001)，其中术后球镜度数±0.5 D占28眼(82.4%)，±1.0 D占31眼(91.2%)。LogMAR UCVA从术前1.40(1.30，1.70)改善至术后(0.28±0.20) D，LogMAR BCVA由术前0.40(0.22，0.70)改善至术后0.15(0.00，0.30)，差异均有统计学意义(均P<0.001)。术后BCVA较术前提高3.00(1.00，5.00)行，所有患者均无BCVA丢失。术前、术后1 d、末次随访眼压值比较差异有统计学意义(F=8.779 P=0.012)，其中术后1 d较术前眼压增高(Z=-3.401，P=0.001)，而末次随访较术后1 d眼压降低(Z=-2.685，P=0.007)，末次随访与术前眼压之间比较差异无统计学意义(Z=-0.894，P=0.371)。角膜内皮细胞计数从术前(2 782.20±296.30)个/mm²降低至术后(2 472.54±394.32)个/mm² (t=-5.437，P<0.001)，平均丢失角膜内皮细胞数11.2%。末次随访33眼平均拱高值为(379.00±283.27)μm，其中0~250 μm占12眼(36.4%)，250~750 μm占19眼(57.6%)，大于750 μm占2眼(6%)。21眼PRL术后3个月拱高值为(269.81±194.67)μm，较术后1个月拱高值(373.62±195.75)μm降低(t=?2.917，P=0.009)。术后并发症包括激素性青光眼(1例2眼)、PRL光学面裂痕(1眼)、黄斑出血(1眼)、PRL偏位(2例3眼)。结论：对于超高度近视患者，依镜PRL植入术是一种可供选择的安全、有效的眼内屈光手术方式，但其远期疗效及安全性仍需更长时间和更大样本量进一步观察。

Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm² to postoperative (2 472.54±394.32)/mm² (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia