SK15402001A3 - Stentovacie zariadenie a metóda liečby glaukómu - Google Patents
Stentovacie zariadenie a metóda liečby glaukómu Download PDFInfo
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Description
Oblasť techniky
Predložený vynález všeobecne rieši chirurgickú liečbu glaukómu a vzťahuje sa predovšetkým na zariadenie a metódu priebežného udržania priechodnosti Schlemmovho kanálika pomocou prechádzajúceho vloženého stentu (výstuže), ktorý môže byť chirurgicky umiestnený tak, aby prechádzal aspoň časťou obvodu kanálika a uľahčoval drenáž očnej komorovej vody cez tento stent.
Doterajší stav techniky
Glaukóm je závažný verejný zdravotný problém pretože je hlavnou príčinou slepoty. Slepota, ako výsledok glaukómu, postihuje ako centrálne , tak periférne videnie a má hlavný vplyv na schopnosť indivídua viesť nezávislý život.
Glaukóm je optická neuropatia (poškodenie optického nervu), ktorá sa obvykle vyskytuje za podmienok zvýšeného vnútroočného tlaku. Tlak v oku sa zvyšuje a toto je spojené so zmenami vzhľadu (dané tvarom očnej jamky) a funkcie („slepé škvrny“ vzornom poli). Ak tlak zostáva dostatočne vysoký po dostatočne dlhú dobu, vznikne úplná strata zraku. Vysoký vnútroočný tlak vzniká v oku z dôvodu vnútornej nerovnováhy.
Oko je dutá štruktúra, ktorá obsahuje číru tekutinu nazývanú „komorová voda“. Komorová voda sa tvorí v zadnej očnej komore vriasnatom telese rýchlosťou asi 2,5 mikrolitra za minútu. Tekutina, ktorá sa vytvára takmer konštantnou rýchlosťou, ďalej prechádza okolo šošovky pupilámym otvorom v dúhovke do prednej očnej komory. Akonáhle sa dostane do prednej komory, drénuje sa von zoka dvoma rôznymi spôsobmi. Pri uveosklerálnom postupe tekutina preniká do svalových vlákien riasnatého telesa. Tento spôsob prispieva uľudí k odtoku komorovej vody približne 10 percentami. Primárny spôsob odtoku komorovej vody u ľudí je kanalikulámy spôsob, ktorý využíva sieť trámčiny a Schlemmov kanálik.
Trámčina a Schlemmov kanálik sú lokalizované v spojení medzi dúhovkou a bielkom (sklérou). Toto spojenie alebo roh sa nazýva „uhol“. Trámčina je štruktúra klinového tvaru, ktorá okružuje obvod oka. Je tvorená kolagénnymi snopcami, ktoré sú usporiadané do trojrozmernej sieťovej štruktúry. Snopce sú potiahnuté jednou vrstvou buniek, ktoré sa nazývajú trabekuláme bunky. Priestor medzi snopcami je vyplnený medzibunkovou hmotou, ktorú produkujú trabekuláme bunky. Tieto bunky rovnako produkujú enzýmy, ktoré degradujú medzibunkovú hmotu. Schlemmov kanálik prilieha natrámčinu. Vonkajšie steny trámčiny sú totožné s vnútornými stenami Schlemmovho kanálika. Schlemmov kanálik je trubicovitá štruktúra prebiehajúca okolo obvodu rohovky. Má sa za to, žeSchlemmov kanálik je rozdelený septami do série autonómnych, slepo ukončených kanálikov.
Tekutina prechádza rozstupmi medzi snopcami trámčiny, preniká vnútornou stenou Schlemmovho kanálika dovnútra, prestupuje sériou asi 25 zberných drenážnych kanálikov zo Schlemmovho kanálika doepisklerálneho žilného systému. V normálnej situácii sa produkcie tekutiny rovná jej odtoku avnútroočný tlak ostáva celkom konštantný v rozmedzí medzi 15 a 21 mmHg. Pri glaukóme je rezistencia v odtokovom systéme kanálika abnormálne vysoká.
Najrozšírenejšia forma glaukómu, primámyglaukóm s otvoreným uhlom, má abnormálny odpor, o ktorom sa predpokladá, že je lokalizovaný pozdĺž vonkajšej strany trámčiny a vnútornej stenySchlemmovho kanálika. Existuje domnienka, že abnormálny metabolizmus trabekulámych buniek vedie k nadmernej tvorbe medzibunkovej hmoty alebo tvorbe abnormálne tuhého materiálu v tejto oblasti. Histopatologické vyšetrenieglaukómových očí tiež ukazuje kolaps Schlemmovho kanálika. Primárna forma glaukómu sotvoreným uhlom tvorí približne 85% všetkých prípadov glaukómu. Ostatné formy glaukómu (ako je uzatvorený uhol a sekundárne formy glaukómu) rovnako zahrnujú znížený odtokkalikulámou cestou, ale zvýšená rezistencia je z iných dôvodov, napríklad pre mechanické zablokovanie, zápalové poškodenie tkaniva, bunkové blokády apodobne.
Kvôli vzrastajúcej rezistencii sa zmnožuje komorová voda, pretože nemôže dostatočne rýchlo odtekať. Ako sa zmnožuje komorová voda, vo vnútri oka vzrastávnútroočný tlak (NOT). Zvýšený NOT utláča axóny (nervové výbežky) v optickom nerve a môže rovnako ohroziť cievne zásobenie optického nervu. Optický nerv prenáša obraz videnia do mozgu. Niektoré optické nervy sa zdajú byť citlivejšie na pôsobenie NOT než iné. Zatiaľ čo výskum hľadá spôsoby ochrany optického nervu pred zvýšeným vnútroočným tlakom, doteraz jediným dostupným terapeutickým prístupom priglaukóme je zníženie NOT.
Klinický postup pri liečbe glaukómu je realizovaný v jednotlivých postupných krokoch. Prvou voľbou je medikamentózna liečba. Zámerom lokálneho alebo orálneho podávanania liečiva je buď zníženie tvorby komorovej tekutiny alebo zvýšenie jej odtoku. Bežne dostupné lieky majú časté závažné vedľajšie účinky, napríklad chronické srdečné zlyhanie sprevádzané zadržovaním tekutiny s tvorbou opuchov, dýchacie ťažkosti, hypertenziu, depresiu a smrť. Hlavným problémom medikamentóznej liečby je prispôsobenie sa medikácii pretože bolo zistené, že viacej než polovica pacientov trpiacich glaukómom nedodržuje správne dávkovanie.
Ak medikamentózna liečba zníženia vnútroočného tlaku zlyháva, uskutočňuje sa často laserová trabekuloplastika. Pri tejto metóde je tepelná energia lasera aplikovaná na niekoľko nesusediacich miest v trámčine. Existuje domnienka, že laserová energia stimuluje nejakým spôsobom metabolizmustrabekulámych buniek a mení medzibunkovú hmotu v sieti trámčiny. Zhruba u 80% pacientov dôjde ku zvýšeniu odtokuvnútrokomorovej vody aNOT klesá. Avšak účinok nie je trvalý a u 50% pacientov sa počas piatich rokov vyvinie opäť vysoký NOT. Laserová chirurgia nie je opakovateľná. Je treba dodať, že laserovátrabekuloplastika nie je efektívnou liečbou ani v prípade primárnej formy glaukómu sotvoreným uhlom u pacientov mladších ako päťdesiat rokov, ani preglaukóm s uzatvoreným uhlom alebo iné sekundárne formyglaukómu.
Najčastejšie uskutočňovanou filtračnou technikou jetrabekuloktómia. Pri trabekuloktómii sa vytvorí v spojivke, priehľadnom tkanive, ktoré pokrýva skléru, zadný rez. Pretiahnutím spojivky dopredu sa skléra priloží na okraj. Vytvorí sa sklerálna chlopňa avotne sa polovičnou hrúbkou do rohovky. Predná komora je vyvedená podsklerálnu chlopňu a časť hlbokej skléry atrámčina je odstránená. Sklerálna chlopňa sa prišije naspäť na miesto. Spojivkový rez je tesne uzatvorený. Po operácii tekutina prechádza otvorom podsklerálnou chlopňou a zhromažďuje sa vo zvýšenom priestore pod spojivkou. Tekutinaje potom buď absorbovaná krvnými cievami spojivky alebo prechádza cez spojivku do slzného filmu.
Trabekuloktómia je sprevádzaná radom problémov.Fibroblasty (väzivové bunky), ktoré sú prítomné v episklére, sa rýchlo množia a migrujú a môžu tak trvalo poškodiť tvorbou väziva (jazvou) sklerálnu chlopňu. Poškodenie vyplývajúce z jazvenia sa môže objaviť predovšetkým u detí a mladistvých. U očí, u ktorých bola uskutočnená úspešná trabekukloktómia, sa v osemdesiatich percentách prejaví zlyhanie v dôsledku jazvenia počas troch až piatich rokov po chirurgickom zákroku. K minimalizácii jazvenia sklerálnej chlopne po chirurgickom zákroku sa vsúčastnej dobe užívajúantifíbrózne látky ako jemitomycín C (MMC) a 5-fluorouracil (5-FU). Použitie týchto látok zvýšilo úspešnosťtrabekuloktómie, ale tiež zvýšilo výskyt hypotónie. Hypotónia je problém, ktorý vzniká pokiaľ očná voda odteká príliš rýchlo. Očný tlak klesá príliš nízko (obvykle pod 6mmHg), štruktúra oka kolabuje a videnie sa horší.
Trabekuloktómia vytvára cestu na únik tekutiny na povrch oka. Súčastne vytvára cestu pre vstup baktérií, ktoré normálne žijú na povrchu oka a na očnom viečku. Pokiaľ toto nastane, môže sa objaviť vnútroočná infekcia nazývaná endoftalmitis. Tá vedie často k trvalej a hlbokej strate zraku. Endoftalmitis sa môže prejaviť kedykoľvek potrabekuloktómii. Riziko stúpa s tvorbou tenkých pľuzgierikov, ktoré sa vyvíjajú po MMC a 5-FU. Ďalším faktorom, ktorý prispieva k infekcii je umiestnenie pľuzgierikov. U očí, kde bola uskutočnená trabekuloktómia dole, je riziko vzniku očnej infekcie päťnásobne vyššie oproti očiam, ktoré majú hornú trabekuloktómiu. Preto sa prednostne uskutočňuje počiatočná trabekuloktómia pod viečkom v nazálnom alebo spánkovom kvadrante.
Kjazveniu, hypotónii a infekcii po trabekuloktómii je nutné uviesť ešte ďalšie komplikácie. Pľuzgierik sa môže roztrhnúť a povedie k ťažkej hypotónii. Pľuzgierik môže byť dráždený a môže poškodiť normálny slzný film, čo vedie k rozostrenému videniu. Pacienti, ktorí majú pľuzgieriky, všeobecne nemôžu nosiť kontaktné šošovky.
Všetky komplikácie trabekuloktómie vyplývajú zo skutočnosti, že tekutina je odvádzaná z vnútra oka na vonkajší povrch.
Pokiaľ trabekuloktómia nezníži úspešne očný tlak, ďalší chirurgický výkon predstavuje vytvorenie drenážnej spojky (skratu, shuntu). Odklonenie tokuvnútroočnej tekutiny doteraz zabezpečuje silikónová trubička, ktorá je jedným koncom pripojená na plastovú doštičku z polypropylénu alebo iného syntetického materiálu. Udrenážnej spojky sa rez, ktorý odhaľuje skléru, uskutočňuje v spojivke. Plastická doštička sa našije na povrch oka dozadu, obvykle nad ekvátor. Otvor do oka vplnej hrúbke sa uskutoční v oblasti okraja, obvykle pomocou ihly. Do oka sa týmto otvorom vloží trubička. Vonkajšia časť trubičky sa pokrýva buď sklérou aleboperikardom darcu. Spojivka sa znovu umiestni na svoje miesto aincízia je tesne uzatvorená. Existuje rad problémov pri súčastne používanej technológii drenážnej spojky, ktoré zahrnujú jazvenie, hypotóniu, zlyhanie spojky ainfekciu.
Niektoré skoršie zmienky o liečbe glaukómuboli zamerané na oblasťSchlemmovho kanálika, nezahrnovali však dlhodobo vložený stent (výstuž). Napríklad US patent No 5 360 399 spomína umiestnenie plastovej alebo oceľovej trubičky do Schlemmovho kanálika zároveň s injektovaním viskózneho materiálu touto trubičkou tak, aby došlo k disekcii (rozrušeniu) trámčiny. Trubička je po injektovaní z kanálika odstránená. Ďalej, vo vzťahu na oblasť Schlemmovho kanálika, je v uvedenom patente spomínané zariadenie, ktoré má injekčnú manžetu väčšieho priemeru, ktorá slúži ako adaptér na injekcie a výplachy. Preto toto zariadenie nie je prispôsobené na trvalé umiestnenie doSchlemmovho kanálika.
Je tu teda potrebné získať fyziologickej ší systém na zvýšenie drenáže komorovej vody Schlemmovým kanálikom. Zvýšený tok tekutiny priamo do Schlemmoho kanálika by minimalizoval jazvenie, pretože oblasť uhla je krytá jednou vrstvou nepreliferujúcich trabekulámych buniek. Zvýšený tok tekutiny priamo do Schlemmovho kanálika by minimalizoval hypotóniu, pretože kanálik je súčasťou prirodzeného odtokového systému a je biologicky konštruovaný tak, aby udržal normálny objem komorovej vody. Zvýšený tok tekutiny priamo doSchlemmovho kanálika by zabránil komplikáciám ako je endoftalmitída a únik.
Podstata vynálezu
Predložený vynález rieši novýstent - výstuž a príslušnú chirurgickú metódu na chirurgickú korekciu glaukómu, keďstent je umiestnený doSchlemmovho kanálika, aby rozšíril priemer kanálika a udržal priestupnosť. Predložený vynález teda uľahčuje normálnu fyziologickú cestu drenáže komorovej vody do Schlemmovho kanálika. Predložený vynález ukazuje využitie permanentného vloženéhostentu doSchlemmovho kanálika pre liečbu glaukómu.
Prehľad obrázkov na výkresoch
Obr.l predstavuje bočný pohľad na jednu súčasť predkladaného vynálezu, na ktorom je vynájdený stent tvorený tubulámym telesom, ktoré prechádza obvodom Schlemmovho kanálika.
Obr.2 predstavuje ďalšiu súčasť predkladaného vynálezu, na ktorom je vynájdený stent tvorený mešovaným (sieťovaným)tubulámym telesom s priesvitom.
Obr.3 predstavuje ďalšiu súčasť predkladaného vynálezu, na ktorom je vynájdený stent tvorený telesami, ktoré sú vo svojej konfigurácii čiastočnetubuláme a čiastočne otvorené.
Obr.4 predstavuje anatomické detaily ľudského oka.
Obr.5 predstavuje anatomické vzťahy chirurgického umiestnenia príslušnej súčasti opisovanej v predkladanom vynáleze.
Príklady uskutočnenia vynálezu
Predkladaný vynález prezentuje stentové zariadenie pre drenáž komorovej vody, ktoré sa umiestňuje do Schlemmovho kanálika ako vložený implantát na rozopnutie a udržanie priechodnosti kanálika, v ktorom stentovacie zariadenie zahrnuje tvarované teleso prijímané Schlemmovým kanálikom tak, aby udržalo prirodzenú drenáž komorovej vody zbernými kanálikmi oka.
Prezentovaný vynález tiež predkladá súčasti vynájdených stentov, ktoré tvorí tenké teleso z biokompatibilného vynálezu, ktorého dĺžka a tvar môžu byť adaptované tak, aby bolo prijaté Schlemmovým kanálikom a vypĺňalo časť na obvode Schlemmovho kanálika a vytvorilo tak cestu na uľahčenie odtoku komorovej vodySchlemmovým kanálikom do zberných kanálikov. Vynález zvažuje rôzne konfiguráciestentovacieho zariadenia a predpokladá, že každá pomáha drenáži Schlemmovým kanálikom udržiavaním priesvitu alebo kapilárnym účinkom. V niektorých súčastiach vynálezu sa telesostentu môže hýbať medzi prvou pozíciou inzercie a druhou pozíciou expandovanéhostentu, ak je táto zamýšľaná pozícia v kanáliku.
Predkladaný vynález tiež stanovuje metódy na užitie stentovacieho zariadenia. Jedna časť prezentovaného vynálezu je nasmerovaná na chirurgickú metódu implantácie vynájdeného stentu do časti obvoduSchlemmovho kanálika. Zariadenie vložené doSchlemmovho kanálika môže byť vyrobené z ohybného, pórovitého alebo nepórovitého, biologicky inertného materiálu s veľkosťou približne rovnakou ako je polomer zakrivenia alebo priemer Schlemmovho kanálika. Celé alebo časť zariadenia môže byťtubulárne alebo netubuláme a dierované (fenestrované) alebo nedierované. Veľkosť zariadenia môže byť ďalej upravovaná tak, aby dovolila umiestnenie do celého alebo len časti obvoduSchlemmovho kanálika.
Tradičné znalosti o glaukóme ustanovujú, žeSchlemmov kanálik je u dospelých rozdelený septami na oddelené kanály, čo znemožňuje uskutočniť úplné spriechodnenie spojenia. Predbežné štúdie, uskutočňované na očiach dospelých z očnej banky, však preukázali, že Schlemmov kanálik je priechodný. Spojením môže byť preniknuté po celom obvode kanálika. Nie je teda doteraz určené, či Schlemmov kanálik je priechodný po celom svojom obvode u normálnych jedincov alebo rozdelený septami do viacnásobných zaslepených kanálikov. Predkladaný vynález využíva tieto znalosti na to, aby udržal priechodnosť Schlemmovho kanálika pomocou predkladanéhostentovacieho zariadenia.
Jedna súčasť prezentovaného vynálezu je zobrazená na obrázku 1, na ktorom jestentovacie zariadenie 100 ukázané z bočnej strany. Stentovacie zariadenie 100 sa skladá z tubulámej časti 10 obsahujúcej priesvit (lumen) 5, ktorá môže mať solídnutubulámu stenu alebo môže obsahovať množstvo otvorov 15, ktorými komunikujelumen a vonkajší priestor. Tubuláma časť má preformované zakrivenie s polomerom približne rovnakým, ako je polomer Schlemmvoho kanálika dospelého oka, t.j. 6 milimetrov. Priečny priemer častiJ0 je takej veľkosti, aby sa úplne dostal do Schlemmovho kanálika. Časť JO je buď uzatvorená tubuláma alebo mnohostranná štruktúra alebo môže byť tiež plochá, uhlová alebo zakrivená otvorená štruktúra alebo nejaká kombinácia vyššie uvedených, keď sa pretne na rôznych miestach pozdĺž svojho priebehu. Otvory Γ5 môžu byť umiestnené pozdĺž akejkoľvek časti zariadenia 100 tak, aby tadiaľ uľahčovali prienik tekutiny.
Ďalšie príklady súčastí prezentovaného zariadenia sú ukázané na obrázkoch 2 a 3. Obrázok 2 ukazuje súčasť vynájdeného stentu, v ktorom zariadenie 100 obsahuje luminámu tubulámu
I sieť a ukazuje jeho konfiguráciu, opäť s preformovaným zakrivením s polomerom r, približne mm, čo je polomerSchlemmovho kanálika a s priečnym priemerom časti 100 takej veľkosti, aby sa úplne dostal doSchlemmovho kanálika.
Obrázok 3 ukazuje teleso vynájdenéhostentu, pri ktorom je časť 10 otvorená a zakrivená po celej svojej dĺžke do prestupujúceho kanála, opäť s pripravovaným zakrivením s polomerom r, približne 6 mm, čo je polomerSchlemmovho kanálika a s priečnym priemerom časti W takej veľkosti, aby sa úplne dostal doSchlemmovho kanálika.
Keďže vynájdené zariadenie je dlhodobý implantát, môže byť vyrobené z materiálu, ktorý môže byť vložený do tkanív a tekutín, s ktorými je v kontakte. Dáva sa prednosť tomu, aby zariadenie nebolo absorbované,korodované alebo inak zmenené počas svojej existencie in situ. Navyše sa preferuje, aby očné tkanivo amok neboli škodlivo postihnuté prítomnosťou implantovaného zariadenia. Rad materiálov vyhovuje zostrojeniu alekárskym požiadavkám na stent. V uvedených súčastiach prezentovaného vynálezu je stentovacie zariadenie WO konštruované z biologicky inertného, ohybného materiálu ako je silikón alebo podobné polyméry. Alternatívne materiály môžu obsahovať, ale nie sú limitované na, tenkostenný polytetrafluóretylén, polypropylén alebo ďalšie polyméry. Môžu sa používať ďalšie kovy a zliatiny známe pre vytváranie stentov, ako je nerezová oceľ, titan alebonitinol. Stenty môžu byť vyrábané s terapeutickými látkami a môžu sa počas doby uvoľňovať zo zariadenia.
V telese, zobrazenom na obrázkoch 1 až 5, časť W má pripravené zakrivenie s polomerom približne 6 mm, ako je zakrivenie Schlemmovho kanálika v ľudskom oku. Súčasť 10 môže byť dostatočne dlhá, aby prešla obvodomSchlemmovho kanálika, celková dĺžka časti 10 je od 1,0 mm do 40,0 mm alebo od 2,0 mm do 20,0 mm alebo 5 mm, aby dovolila umiestnenie po obvode Schlemmovho kanálika. Priemer, alebo šírka časti W je takej veľkosti, aby vytvárala vnútorný priemer medzi 0,1-0,5 mm, najlepšie 0,2 mm a vonkajšie priemer 0,1 mm a 0,5 mm alebo okolo 0,3 mm pre tubuláme zakrivený stent alebo porovnateľnú šírku pre stent s mnohouhlovou konfiguráciou. Časť 10 môže obsahovať množstvo otvorov, dovoľujúcich odtok tekutiny a usporiadaných tak, aby predchádzali uzatvoreniu priľahlou stenou Schlemmovho kanálika, hlavne v smere zberného kanálika.
Chirurgické rezy, ktoré sa vzťahujú na predkladaný vynález, sú zobrazené na obrázku 4. Všeobecne obrázok 4 ukazuje prednú komoru35. Schlemmov kanálik 30, dúhovku (iris)40, rohovku (komeu) 45, trámčinu 50, zberný kanálik 55, episklerálne žily60, panenku (pupilu) a šošovku (lens) 70. Obrázok 5 ilustruje chirurgické umiestnenie uvedeného telesa v predkladanom vynáleze so skutočnými anatomickými vzťahmi. Nutné je poznamenať, že vynájdené zariadenie je konštruované tak, že umiestnenie viacnásobných stentov do Schlemmovho kanálika 30 môže vyústiť takmer do okrúženia Schlemmovho kanálika. Chirurgický rez do Schlemmovho kanálika je uzatvorený, nie je tu žiadna komunikáciastentu s vonkajším prostredím.
Chirurgická procedúra, ktorá potrebuje umiestniť zariadenie, môže obsahovať niektoré z nasledujúcich krokov: Spojivkový rez. Sklerálna chlopňa s čiastočnou silou je potom vytvorená avseknutá polovicou hrúbky do rohovky. Je zistená zadná polohaSchlemmovho kanálika a do kanálika sa vstupuje zozadu. Predná komora môže byť prehĺbená vstreknutím visokoelastického alebo miotického činidla. Balónikový katéter, ktorý je popisovaný v U.S.Seriál NO. , z 26.apríla 2000, môže byť zavedený do Schlemmovho kanálika a nafúknutý, aby dilatoval časť Schlemmovho kanálika, toto je nasledované selektívnym vyfúknutím balónika a umiestnením jedného alebo viacerých stentovacích zariadení do Schlemmovho kanálika. Alternatívne môže byť stentovacie zariadenie zavedené priamo na balóniko vitom katéterizačnom zariadení.
Zatiaľ, čo vyššie uvedené súčasti sú typické, vynález uvažuje širokú škálu tvarov a konfigurácií stentov, ktoré umožňujú komunikáciu tekutiny medzi prednou komorou a Schlemmovým kanálikom a zberným kanálikom. Nie je teda zamýšľané, aby vyššie popísané súčasti boli limitované na rozsah požiadaviek a ekvivalentov.
Claims (9)
- PATENTOVÉ NÁROKY1. Stent na zníženie nadmerného vnútroočného tlaku pomocou odvodnenia cez a vo vnútri Schlemmovho kanálika, pozostávajúci z tenučkého telieska z biologicky kompatibilného materiálu, prispôsobeného dĺžkou a tvarom tak, aby mohol byť celkom pojatý časťou Schlemmovho kanálika, vyznačujúci sa tým, žea) uvedené teliesko je oblúkovité tak, aby definovalo korýtkový, čiastočne otvorený kanálik pozdĺž aspoň časti dĺžky spomenutého telieska a je otvorený smerom na zberné kanáliky oka,b) uvedené teliesko má vonkajší priemer okolo 0,1 mm až 0,5 mm ac) uvedené teliesko má dĺžku okolo 1 mm až 40 mm.
- 2. Stent podľa nároku 1,vyznačujúci sa tým, že uvedené teliesko zabezpečuje odvodnenie v oboch smeroch pozdížSchlemmovho kanálika.
- 3. Stent podľa nároku l,vyznačujúci sa tým, že teliesko je aspoň čiastočne vybavené priesvitom (luminálne).
- 4. Stent podľa nároku 1,vyznačuj úci sa tým, že uvedené teliesko je oblúkové a j eho polomer zodpovedá približne polomeru Schlemmovho kanálika v ľudskom oku, pričom polomer je medzi 3 mm a 10 mm.
- 5. Stent podľa nárokov laž 4, vyznač uj úci sa tým, že uvedené teliesko je oblúkové a jeho polomer je okolo 6 mm.
- 6. Stent podľa nárokov laž 4, vyznačujúci sa tým, že uvedené teliesko má vonkajší priemer okolo 0,3 mm.
- 7. Stent podľa nárokov laž 4, vyznačujúci sa tým, že uvedené teliesko má dĺžku okolo 20 mm.
- 8. Stent podľa nárokov laž 4, vyznačujúci sa tým, že uvedené teliesko je vybavené radom otvorov (fenestrované), ktoré umožňujú priechod tekutiny do Schlemmovho kanálika.
- 9. Spôsob chirurgického ošetrenia glaukómu, pri ktorom sa uskutočňujetrabekuloktómia cez spojivkovú lalok v okraji; vytvorenie sklerálnej chlopne čiastočnej hrúbky, radiálny rez spojením medzi tkanivom uhla a sklérou, ktorý je chirurgicky rozšírený až tak, pokiaľ nie je Schlemmov kanálik dosiahnutý zo zadnej strany apokiaľ sa nedosiahne umiestnenie jedného alebo viacerýchstentovacích zariadení podľa nárokov 1 až 8.
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US13103099P | 1999-04-26 | 1999-04-26 | |
PCT/US2000/011215 WO2000064391A1 (en) | 1999-04-26 | 2000-04-26 | Stent device and method for treating glaucoma |
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SK1540-2001A SK15402001A3 (sk) | 1999-04-26 | 2000-04-26 | Stentovacie zariadenie a metóda liečby glaukómu |
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SI (1) | SI1173124T1 (sk) |
SK (2) | SK15392001A3 (sk) |
TR (2) | TR200103098T2 (sk) |
WO (4) | WO2000064393A1 (sk) |
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