CN112168478A - Implanted DSAEK surgical kit and corneal endothelium implantation method - Google Patents
Implanted DSAEK surgical kit and corneal endothelium implantation method Download PDFInfo
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- CN112168478A CN112168478A CN202011122599.8A CN202011122599A CN112168478A CN 112168478 A CN112168478 A CN 112168478A CN 202011122599 A CN202011122599 A CN 202011122599A CN 112168478 A CN112168478 A CN 112168478A
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- corneal endothelium
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- 210000000871 endothelium corneal Anatomy 0.000 title claims abstract description 55
- 238000002513 implantation Methods 0.000 title claims abstract description 32
- 238000000034 method Methods 0.000 title claims abstract description 27
- 210000002159 anterior chamber Anatomy 0.000 claims abstract description 25
- 210000003038 endothelium Anatomy 0.000 claims abstract description 15
- 239000007943 implant Substances 0.000 claims abstract description 11
- 230000003511 endothelial effect Effects 0.000 claims description 34
- 238000002347 injection Methods 0.000 claims description 31
- 239000007924 injection Substances 0.000 claims description 31
- 210000003128 head Anatomy 0.000 claims description 10
- 210000000744 eyelid Anatomy 0.000 claims description 7
- 230000007704 transition Effects 0.000 claims description 4
- 238000001802 infusion Methods 0.000 claims 1
- 230000010412 perfusion Effects 0.000 abstract description 5
- 238000005516 engineering process Methods 0.000 abstract description 2
- 208000002177 Cataract Diseases 0.000 abstract 1
- 238000002054 transplantation Methods 0.000 description 15
- 210000002889 endothelial cell Anatomy 0.000 description 6
- 238000001356 surgical procedure Methods 0.000 description 4
- 206010002091 Anaesthesia Diseases 0.000 description 3
- 230000037005 anaesthesia Effects 0.000 description 3
- 230000007547 defect Effects 0.000 description 3
- 238000000926 separation method Methods 0.000 description 3
- 238000010586 diagram Methods 0.000 description 2
- 238000011010 flushing procedure Methods 0.000 description 2
- 230000000149 penetrating effect Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 239000000243 solution Substances 0.000 description 2
- 206010051093 Cardiopulmonary failure Diseases 0.000 description 1
- 206010010356 Congenital anomaly Diseases 0.000 description 1
- 206010058314 Dysplasia Diseases 0.000 description 1
- 206010015943 Eye inflammation Diseases 0.000 description 1
- 208000000857 Hepatic Insufficiency Diseases 0.000 description 1
- 206010019663 Hepatic failure Diseases 0.000 description 1
- 206010061218 Inflammation Diseases 0.000 description 1
- 208000032984 Intraoperative Complications Diseases 0.000 description 1
- 208000035965 Postoperative Complications Diseases 0.000 description 1
- 206010057765 Procedural complication Diseases 0.000 description 1
- 208000012287 Prolapse Diseases 0.000 description 1
- 208000001647 Renal Insufficiency Diseases 0.000 description 1
- 206010060872 Transplant failure Diseases 0.000 description 1
- 208000025865 Ulcer Diseases 0.000 description 1
- 206010046851 Uveitis Diseases 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 210000005252 bulbus oculi Anatomy 0.000 description 1
- 230000006727 cell loss Effects 0.000 description 1
- 210000003683 corneal stroma Anatomy 0.000 description 1
- 230000002440 hepatic effect Effects 0.000 description 1
- 230000001771 impaired effect Effects 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
- 206010023332 keratitis Diseases 0.000 description 1
- 206010023365 keratopathy Diseases 0.000 description 1
- 201000006370 kidney failure Diseases 0.000 description 1
- 238000002690 local anesthesia Methods 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000008447 perception Effects 0.000 description 1
- 239000011148 porous material Substances 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 230000001737 promoting effect Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 231100000397 ulcer Toxicity 0.000 description 1
- 230000000007 visual effect Effects 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/0008—Introducing ophthalmic products into the ocular cavity or retaining products therein
- A61F9/0017—Introducing ophthalmic products into the ocular cavity or retaining products therein implantable in, or in contact with, the eye, e.g. ocular inserts
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- Health & Medical Sciences (AREA)
- Ophthalmology & Optometry (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
An implanted DSAEK operation kit and a corneal endothelium implantation method are disclosed, wherein a special corneal endothelium implantation injector is designed by referring to an implantation mode of an intraocular lens, and related operation auxiliary instruments are developed, anterior chamber perfusion is not needed, a corneal implant of the DSAEK is injected into an anterior chamber through a transparent corneal incision of 3.0mm, complications in an operation process are avoided, the number of endothelium losses is reduced, and the implanted DSAEK operation kit and the corneal endothelium implantation method are widely applied to cataract operations and have no obvious complications. And the technology is tried to be applied in clinic at present, and no complication occurs.
Description
Technical Field
The invention relates to the technical field of corneal endothelium transplantation, in particular to an implantable DSAEK surgical kit and a corneal endothelium implantation method.
Background
Since the advent of the 2000 s corneal transplantation, corneal endothelial transplantation was rapidly accepted by a large number of surgeons and became the first surgical formula for corneal endothelial decompensation, and compared with penetrating corneal transplantation, the visual recovery after endothelial transplantation was faster and intraoperative and postoperative complications were less, in the united states, the number of corneal endothelial transplantation operations rapidly increased, increased by 20 times in recent years and exceeded the number of penetrating corneal transplantation operations, becoming the first corneal transplantation operation for treating corneal endothelial decompensation. Corneal endothelial transplantation is divided into two operation modes, namely, a corneal automatic lamellar knife material-taking elastic layer peeling corneal endothelial transplantation DSAEK and a posterior elastic layer corneal endothelial transplantation DMEK, and although the DMEK operation has lower rejection rate and better postoperative vision, the DMEK operation has high requirements on materials, needs a donor over 60 years old, has high operation difficulty and long learning curve and is not widely developed in China, so the mainstream endothelial transplantation operation mode in China at present is the DSAEK. The main technical difficulty to be overcome in the endothelial transplantation operation is to reduce the number of lost endothelial cells, the implantation process is the first key step, and if a large amount of endothelial cells are lost in the implantation process, the graft dislocation and primary graft failure can be caused. The initial endothelial implantation procedure involved folding the implant into a crimped shape and implanting the implant into the anterior chamber through a 5mm corneoscleral incision using forceps, with an average endothelial cell loss of 42% for 1 year due to damage to the corneal endothelium by the forceps upon folding. In view of the problems associated with the traditional folded implantation, implantation using an endothelial implantation instrument is currently the mainstream procedure, placing the endothelium in a spatula, pulling it through a suture or forceps, and removing it into the anterior chamber. However, due to the large incision, the anterior chamber is unstable during the prolapse procedure, and continuous perfusion of the anterior chamber is required to maintain the anterior chamber, which can cause complications such as flushing out and loss of the endothelial sheet.
Disclosure of Invention
In order to solve the defects of the prior art, avoid complications in the operation process and reduce the loss amount of endothelial cells, the invention provides an implanted DSAEK operation kit and a corneal endothelial implantation method, which use the implantation mode of an intraocular lens as a reference, design a special injector for corneal endothelial implantation, develop related operation auxiliary instruments, inject a DSAEK corneal implant into an anterior chamber through a transparent corneal incision of 3.0mm, do not need anterior chamber perfusion in the operation process, and play a role in promoting the popularization of endothelial transplantation operations in China.
The technical solution adopted by the invention is as follows: an implantable DSAEK surgical kit comprising a corneal endothelium injector for corneal endothelium implantation, an endothelium hook for adjusting the position of the implanted corneal endothelium, and a bubble injection head for expanding the implanted corneal endothelium. The corneal endothelium injector comprises an injection tube and a placing part for placing the implanted corneal endothelium, and the injection tube is connected with the placing part. The placing part comprises a fixed end and a movable end, the fixed end is hinged with the movable end, a separation position is arranged between the fixed end and the movable end, and a closed position of the tubular placing part is formed after the fixed end and the movable end are closed. All be equipped with the extension on the outer fringe of stiff end and expansion end, extension lock joint cooperation between stiff end and the expansion end makes to reach fixedly between stiff end and the expansion end after the realization closure to form pipy portion of placing.
The fixed end and the injection pipe are arranged in a collinear way, and the joint of the movable end and one side of the fixed end is in hinged fit.
The movable end and the fixed end are respectively provided with a limiting boss and a limiting groove, and the movable end and the fixed end are fixedly connected through the limiting boss and the limiting groove.
The endothelial hook comprises a rod body, wherein one end of the rod body is provided with an adjusting rod, the adjusting rod comprises a main body arranged in a collinear manner with the rod body and an extension part forming an included angle with the main body, and the end part of the extension part is provided with a contact end.
The contact end is cylindrical, the upper end surface of the contact end is arc-shaped, and the contact end and the extension part are vertically arranged.
The top of the contact end is also provided with a spherical bulge.
The connecting part between the contact end and the extension part is in smooth transition.
The included angle between the extension part and the main body is an obtuse angle.
The bubble injection head comprises a connecting part, an input pipe is connected to the connecting part, the pipe body of the input pipe is in a fold line shape, the tail end of the input pipe is connected with the connecting part, and an obtuse included angle is formed between the front end and the tail end of the input pipe.
The joint of the tail end and the front end of the input pipe is in smooth transition, the pipe diameter of the pipe body from the tail end to the front end is reduced, and 4 pore channels are respectively arranged on two sides of the front end of the input pipe
A corneal endothelial implantation method employing an implantable DSAEK surgical kit, comprising the steps of: the method comprises the steps of performing eyelid opening with a microscopic eyelid opener or a suture to make a 3.0mm transparent corneal incision, placing corneal endothelium into a placing part of a corneal endothelium injector to enable the corneal endothelium to face upwards, extending an extending part of an endothelium hook into an injection pipe of the corneal endothelium injector, slowly and completely drawing the corneal endothelium in the placing part into the injection pipe through a contact end on the extending part to avoid damaging the endothelium, injecting the corneal endothelium in the injection pipe into an anterior chamber through the transparent corneal incision through injection of the corneal endothelium injector, suturing the corneal incision, injecting bubbles into a side hole through an input pipe to inject the bubbles into the anterior chamber, expanding endothelial sheets towards two sides, enabling the endothelium to be fully flattened and attached to a corneal implant bed, and completing corneal endothelium implantation.
The invention has the beneficial effects that: the invention provides an implanted DSAEK surgical kit and a corneal endothelium implantation method, which use the implantation mode of an intraocular lens as a reference, design a special corneal endothelium implantation injector and develop related surgical auxiliary instruments. The anterior chamber is not needed to be filled in the implantation operation process, and the corneal implant of the DSAEK is injected into the anterior chamber through the transparent corneal incision of 3.0mm, so that the complication in the operation process can be avoided, and the loss amount of endothelial cells can be reduced. And the technology is tried to be applied in clinic at present, and no complication occurs.
Drawings
Fig. 1 is a schematic structural diagram of a corneal endothelial injector according to the present invention. Fig. 2 is a schematic structural diagram of a corneal endothelial injector according to the present invention.
Fig. 3 is a schematic view of the structure of the endothelial hook of the present invention.
Fig. 4 is a schematic view of the structure of the adjusting rod of the endothelial hook of the invention.
FIG. 5 is a schematic view of a bubble injection head according to the present invention.
FIG. 6 is a schematic view of the front end structure of the input tube of the bubble injection head according to the present invention. The injection device comprises an injection pipe 1, a placing part 2, a rod body 3, an adjusting rod 4, a connecting part 5, an input pipe 6, an opening 7, a fixed end 21, a movable end 22, an extending part 23, a main body 41, an extending part 42 and a contact end 43.
Detailed Description
The invention is described below with reference to fig. 1, fig. 2, fig. 3, fig. 4, fig. 5, and fig. 6, and an implantable DSAEK surgical kit includes a corneal endothelium injector for corneal endothelium implantation, an endothelial hook for adjusting a position of an implanted corneal endothelium, and a bubble injection head for expanding the implanted corneal endothelium, the corneal endothelium injector includes an injection tube 1 and a placement portion 2 for placing the implanted corneal endothelium, and the injection tube 1 is connected to the placement portion 2. The placing part 2 comprises a fixed end 21 and a movable end 22, the fixed end 21 and the movable end 22 are in hinged fit, the fixed end 21 and the movable end 22 comprise a separation position and a closing position, and the separation position and the closing position form the tubular placing part 2 after the fixed end 21 and the movable end are closed. Extension portions 23 are arranged on the outer edges of the fixed end 21 and the movable end 22, the extension portions 23 of the fixed end 21 and the movable end 22 are in buckling fit, and after the fixed end 21 and the movable end 22 are closed, the fixed end 21 and the movable end 22 are fixed, so that the tubular placing portion 2 is formed. The fixed end 21 and the injection pipe 1 are arranged in a collinear way, and the joint of the movable end 22 and one side of the fixed end 21 is in hinged fit. The movable end 22 and the fixed end 21 are respectively provided with a limiting boss and a limiting groove, and the movable end 22 and the fixed end 21 are fixedly connected through the limiting boss and the limiting groove.
The inner skin hook comprises a rod body 3, an adjusting rod 4 is arranged at one end of the rod body 3, the adjusting rod 4 comprises a main body 41 arranged in a collinear mode with the rod body 3 and an extension portion 42 forming an included angle with the main body 41, and a contact end 43 is arranged at the end portion of the extension portion 42. The contact end 43 is cylindrical, the upper end surface of the contact end 43 is circular arc-shaped, and the contact end 43 and the extension portion 42 are vertically arranged. The top of the contact end 43 is also provided with a spherical protrusion. The endothelial hook is smaller in size than a normal hook head, the contact end and the endothelial contact point are smaller, damage to the endothelium can be reduced, and the head of the contact end, which is in contact with the endothelium, is more round rather than pointed.
The included angle between the extension part 42 and the main body 41 is an obtuse angle.
The bubble injection head comprises a connecting part 5, an input pipe 6 is connected to the connecting part 5, the pipe body of the input pipe 6 is in a fold line shape, the tail end of the input pipe 6 is connected with the connecting part 5, and an obtuse included angle is formed between the front end and the tail end of the input pipe 6.
The joint of the tail end and the front end of the input pipe 6 is in smooth transition, and the pipe diameter of the pipe body from the tail end to the front end is reduced. The two sides of the front end of the input pipe 6 are respectively provided with 4 openings 7.
A corneal endothelial implantation method employing an implantable DSAEK surgical kit, comprising the steps of: the method comprises the steps of performing eyelid opening with a microscopic eyelid opener or a suture to make a 3.0mm transparent corneal incision, placing corneal endothelium into a placing part of a corneal endothelium injector to enable the corneal endothelium to face upwards, extending an extending part of an endothelium hook into an injection pipe of the corneal endothelium injector, slowly and completely drawing the corneal endothelium in the placing part into the injection pipe through a contact end on the extending part to avoid damaging the endothelium, injecting the corneal endothelium in the injection pipe into an anterior chamber through the transparent corneal incision through injection of the corneal endothelium injector, suturing the corneal incision, injecting bubbles into a side hole through an input pipe to inject the bubbles into the anterior chamber, expanding endothelial sheets towards two sides, enabling the endothelium to be fully flattened and attached to a corneal implant bed, and completing corneal endothelium implantation.
[ ADAPTION ] various patients with corneal endothelium decompensation have impaired vision which affects their daily lives and work.
[ contraindication ] 1 corneal stroma is turbid. 2. Active inflammation of cornea, ulcer, etc. 3. Active internal eye inflammation, such as uveitis, and resolution of the inflammation within three months. 4. Neuroparalytic keratopathy, corneal perception loss, eyelid defect. 5. Patients with cardiopulmonary insufficiency and serious hepatic and renal insufficiency. 6. Congenital dysplasia of the eyeball, and all other conditions that seriously affect the surgical procedure.
[ preoperative preparation ] same as corneal transplantation.
[ ANESTHESIS ] retrobulbar block anesthesia or peribulbar anesthesia; the infant needs basic anesthesia and local anesthesia.
(postoperative treatment) intracorneal graft.
The traditional folding implantation mode is to fold the implant into a curled shape, and the implant is implanted into the anterior chamber through a 5mm corneoscleral incision by using forceps, so that the defects that the corneal endothelium is damaged by the forceps during folding and the average endothelial loss rate of 1 year is 42 percent exist. The invention also discloses a method for implanting the main current endothelial implanting device, which is characterized in that an endothelium is placed in a shovel and is pulled into the anterior chamber through a suture or forceps, but the anterior chamber is unstable in the process of inserting because of a large incision, the anterior chamber needs to be continuously perfused to maintain the anterior chamber, and the perfusion of the anterior chamber can cause complications such as flushing out and loss of an endothelial sheet.
The injection DSAEK provided by the invention is characterized in that a special corneal endothelium implantation injector is designed by referring to an intraocular lens implantation mode, related surgery auxiliary instruments are developed, a DSAEK corneal implant is injected into the anterior chamber through a 3.0mm transparent corneal incision, anterior chamber perfusion is not needed in the surgery process, complications in the surgery process are avoided, and the loss amount of endothelial cells is reduced.
The above description is only a preferred embodiment of the present invention, and the protection scope of the present invention is not limited to the above embodiments, and all technical solutions belonging to the idea of the present invention belong to the protection scope of the present invention. It should be noted that modifications and embellishments within the scope of the invention may occur to those skilled in the art without departing from the principle of the invention, and are considered to be within the scope of the invention.
Claims (10)
1. An implantable DSAEK surgical kit, which is characterized by comprising a corneal endothelium injector for corneal endothelium implantation, an endothelial hook for adjusting the position of the implanted corneal endothelium and an air bubble injection head for expanding the implanted corneal endothelium, wherein the corneal endothelium injector comprises an injection tube (1) and a placing part (2) for placing the implanted corneal endothelium, the injection tube (1) is connected with the placing part (2), the placing part (2) comprises a fixed end (21) and a movable end (22), the fixed end (21) is hinged with the movable end (22), the fixed end (21) and the movable end (22) are separated from each other and form a closed position of the tubular placing part (2) after being closed, and extension parts (23) are arranged on the outer edges of the fixed end (21) and the movable end (22), the extension parts (23) of the fixed end (21) and the movable end (22) are jointed and matched, so that the fixed end (21) and the movable end (22) are fixed after the fixed end (21) and the movable end (22) are closed, and the tubular placing part (2) is formed.
2. An implantable DSAEK surgical kit according to claim 1, wherein said fixed end (21) is co-linear with the infusion tube (1), and said movable end (22) is pivotally engaged with a connection at one side of the fixed end (21).
3. The implantable DSAEK surgical kit of claim 1, wherein the movable end (22) and the fixed end (21) are respectively provided with a limit boss and a limit groove, and the movable end (22) and the fixed end (21) are fixedly connected through the limit boss and the limit groove.
4. An implantable DSAEK surgical kit according to claim 1, wherein the inner skin hook comprises a shaft (3), an adjusting rod (4) is disposed at one end of the shaft (3), the adjusting rod (4) comprises a main body (41) arranged in line with the shaft (3) and an extension portion (42) forming an angle with the main body (41), and a contact end (43) is disposed at an end of the extension portion (42).
5. The implantable DSAEK surgical kit of claim 4, wherein the contact end (43) is cylindrical, the upper end surface of the contact end (43) is arc-shaped, and the contact end (43) and the extension (42) are vertically disposed.
6. The implantable DSAEK surgical kit of claim 5, wherein the top of the contact end (43) is further provided with a spherical protrusion, and the junction between the contact end (43) and the extension portion (42) is a smooth transition.
7. The implantable DSAEK surgical kit of claim 4, wherein the angle between the extension (42) and the body (41) is obtuse.
8. The implantable DSAEK surgical kit of claim 1, wherein the bubble injection head comprises a connection portion (5), the connection portion (5) is connected to the input tube (6), the body of the input tube (6) is in a zigzag shape, the tail end of the input tube (6) is connected to the connection portion (5), and an obtuse included angle is formed between the front end and the tail end of the input tube (6).
9. The implantable DSAEK surgical kit of claim 8, wherein the connection between the tail end and the front end of the input tube (6) is smoothly transitioned and the tube diameter from the tail end to the front end is reduced, and each of the two sides of the front end of the input tube (6) has 4 openings (7).
10. A method of corneal endothelial implantation using the implantable DSAEK surgical kit of any one of claims 1-9, comprising the steps of: the method comprises the steps of performing eyelid opening with a microscopic eyelid opener or a suture to make a 3.0mm transparent corneal incision, placing corneal endothelium into a placing part of a corneal endothelium injector to enable the corneal endothelium to face upwards, extending an extending part of an endothelium hook into an injection pipe of the corneal endothelium injector, slowly and completely drawing the corneal endothelium in the placing part into the injection pipe through a contact end on the extending part to avoid damaging the endothelium, injecting the corneal endothelium in the injection pipe into an anterior chamber through the transparent corneal incision through injection of the corneal endothelium injector, suturing the corneal incision, injecting bubbles into a side hole through an input pipe to inject the bubbles into the anterior chamber, expanding endothelial sheets towards two sides, enabling the endothelium to be fully flattened and attached to a corneal implant bed, and completing corneal endothelium implantation.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202011122599.8A CN112168478A (en) | 2020-10-20 | 2020-10-20 | Implanted DSAEK surgical kit and corneal endothelium implantation method |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202011122599.8A CN112168478A (en) | 2020-10-20 | 2020-10-20 | Implanted DSAEK surgical kit and corneal endothelium implantation method |
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| CN112168478A true CN112168478A (en) | 2021-01-05 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116098737A (en) * | 2023-01-17 | 2023-05-12 | 中山大学中山眼科中心 | Unfolding device of corneal endothelial implant and application method thereof |
-
2020
- 2020-10-20 CN CN202011122599.8A patent/CN112168478A/en active Pending
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116098737A (en) * | 2023-01-17 | 2023-05-12 | 中山大学中山眼科中心 | Unfolding device of corneal endothelial implant and application method thereof |
| CN116098737B (en) * | 2023-01-17 | 2023-11-24 | 中山大学中山眼科中心 | Unfolding device of corneal endothelial implant and application method thereof |
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