摘要：目的：证明非穿透小梁切除术联合丝裂霉素C及羊膜植入术是治疗常规手术失败后的青少年开角型青光眼的一种安全有效的手术方法。方法：对15例(15眼)曾按常规手术失败的青少年开角性青光眼患者施行非穿透性小梁手术，术中使用丝裂霉素并联合羊膜移植，术后观察视力﹑眼压﹑滤泡及并发症。术后随访(9.2±3.5)个月。结果：术后1年，1眼较术前视力提高，14眼视力无改变，未发现视力下降者；患者术前平均眼压(30.18±4.38)mmHg，术后2周(11.25±2.58)mmHg，1月为(13.18±2.38)mmHg，3月为(14.27±2.55)mmHg，6月为(13.18±2.38)mmHg，1年时为(15.33±3.01)mmHg，术后各时段眼压与术前相比，差异均有显著意义(P<0.01)；术后2周11眼(73.3%)为Ⅰ型功能性滤过泡、4眼(26.7%)为Ⅱ型功能性滤过泡，1眼在3月时滤过泡有轻度包裹，经用针轻挑滤过泡包膜内壁后恢复为Ⅰ型滤过泡，随访1年，15眼仍为Ⅰ、Ⅱ型功能性滤过泡；术后9眼无任何反应，5眼前房水轻度闪辉，术后3～5d消失，1眼前房轻度积血，术后6d吸收。未发生浅前房﹑脉络膜脱离﹑眼内炎及滤过泡渗漏等并发症。结论：非穿透小梁切除术联合丝裂霉素C及羊膜植入术治疗常规手术失败的青少年开角型青光眼是一种安全有效的方法。

    关键词：非穿透小梁切除术；难治性；青少年开角型青光眼；丝裂霉素C；羊膜

    Non-penetrating Trabecular Surgery with Mitomycin-C and Amniotic Membrane Implant Treat the Refractory Juvenile Open Angle Glaucoma

    LI Qiang,WAN Peng-xia

    (Department of Ophthalmology, The People’s Hospital, Huadu District ofGuangzhou, Guangdong Guangzhou 510800,China)

    Abstract： Objective： To prove the safety and effectiveness of non-penetrating trabecular surgery with Mitomycin-C and amniotic membrane implant in treating the refractory juvenile open angle glaucoma that have failed in the routine surgery. Method： Non-penetrating trabecular surgery with Mitomycin-C and amniotic membrane implant was performed on the 15 patients (15 eyes) who have had failed in the routine surgery. Visual acuity, intraocular pressure (IOP), filtering bleb and complications were observed. The post operation follow-up period is (9.2±3.5) months. Results： One year after the operation, 1 eye with better visual acuity than that of preoperation,14 eyes have no change, no eye was found with worse visual acuity than before. Preoperative mean IOP was (30.18±4.38)mmHg, the mean IOP on post-operative 2nd week, 1st, 3rd, 6th month, and 1st year was (11.25±2.58)mmHg, (13.18±2.38)mmHg, (14.27±2.55)mmHg, (13.18±2.38)mmHg, (15.33±3.01)mmHg, the post-operative mean IOPs in every period comparing with that of pre-operation have significant difference. 2 weeks after the operation, 11 eyes (73.3%) with type I functional filtering bleb, 4 eyes (26.7%) with type II functional filtering bleb. 1 eyes with slightly encapsulated bleb 3 months after the operation , and the bleb turn back to type I after broke it’s capsule wall with a needle . 1 year after the operation , 15 eyes still with type I or II functional filtering bleb. After the operation, 9 eyes had no complications. 5 eyes with light aqueous flare which disappeared after 3～5 days. 1 eye with light hyphema, and it was absorbed in the 6th day after the operation. There were no other complications, such as shallow anterior chamber, choroidal detachment, endophthalmitis, filtering bleb leak and so on. Conclusion：Non-penetrating trabecular surgery with Mitomycin-C and amniotic membrane implant is a safe and effective method of treating the refractory juvenile open angle glaucoma that has failed in the routine surgery. ......