目的：观察外伤性开角型青光眼患者进行Ex-press引流钉联合羊膜植入术中应用丝裂霉素C后眼压及视力的变化。

方法：前瞻性系列病例研究。连续收集行Ex-press引流钉联合羊膜植入术中应用丝裂霉素C治疗外伤性开角型青光眼患者18例18眼，分别记录眼压(IOP)、最佳矫正视力(BCVA)、抗青光眼药物数量及并发症。所有患者随访24mo。

结果：术后24mo，15眼取得了绝对成功(未使用抗青光眼药物时IOP<21 mmHg)，成功率为88.2%(15/17)。术前IOP为36.9±4.8 mmHg，术后12mo为15.4±3.5 mmHg，术后24mo为15.5±3.5 mmHg。术后早期有2例患者(11.1%)由于滤过泡纤维化出现了高眼压。大多数患者最后一次复查时BCVA较术前有提高。2例患者(11.1%)术后出现一过性低眼压。术后无前房出血、脉络膜脱离、浅前房、引流器触碰虹膜或引流器脱位等并发症。

结论：Ex-press引流钉联合羊膜植入术中应用丝裂霉素C治疗外伤性开角型青光眼是安全的、有效的，可以作为这类患者的选择。

AIM: To evaluate intraocular pressure(IOP)control and visual rehabilitation after placement of the Ex-press^® miniature glaucoma shunt with adjunctive amniotic membrane transplantation(AMT)and mitomycin C(MMC)in patients with post-traumatic open-angle glaucoma during 2y of follow up.

METHODS: This was an interventional, 2-year, observational study. Eighteen eyes were prospectively observed(in 18 patients with traumatic secondary open-angle glaucoma)in which Ex-press miniature glaucoma filtration shunts were implanted with AMT and MMC. The outcome measures included intraocular pressure(IOP), best corrected visual acuity(BCVA), number of antiglaucoma medications, and complications. The progress of all patients was monitored for 24mo.

RESULTS: Complete success(IOP <21 mmHg without glaucoma medications)was seen in 15 of the 17(88.2%)eyes enrolled in the study at 24mo after the operation. IOP decreased from 36.9±4.8 mmHg preoperatively to 15.4±3.5 mmHg at 12mo and 15.5±3.5 mmHg at 24mo postoperatively. Early postoperative hypertension developed in two patients(11.1%)due to postoperative fibrosis. Most of the patients had improved postoperative BCVA values at the final follow-up visit compared to their preoperative measurements. Two patients(11.1%)developed transient hypotony. There were no complications such as hyphema, choroidal effusion, shallow anterior chamber, the device touching the iris, or extrusion of the device.

CONCLUSION: The Ex-press miniature glaucoma filtration shunt with adjunctive AMT and MMC is effective and safe in cases of traumatic open-angle glaucoma. Surgical management is an appropriate surgical treatment in this series of cases.

浙江省医药卫生科技计划项目(No.2014KYB111); 浙江省自然科学基金资助项目(No. LY13H120002)