WO2023155565A1 - 一种角膜路径单向房水引流器 - Google Patents

一种角膜路径单向房水引流器 Download PDF

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Publication number
WO2023155565A1
WO2023155565A1 PCT/CN2022/138314 CN2022138314W WO2023155565A1 WO 2023155565 A1 WO2023155565 A1 WO 2023155565A1 CN 2022138314 W CN2022138314 W CN 2022138314W WO 2023155565 A1 WO2023155565 A1 WO 2023155565A1
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Prior art keywords
valve unit
tesla valve
aqueous humor
liquid
channel
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PCT/CN2022/138314
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English (en)
French (fr)
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王宁利
毛迎燕
甄毅
杜丽华
辛晨
张伟
申婧
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首都医科大学附属北京同仁医院
北京市眼科研究所
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Publication of WO2023155565A1 publication Critical patent/WO2023155565A1/zh

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F9/00Methods 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
    • A61F9/007Methods or devices for eye surgery
    • A61F9/00781Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F9/00Methods 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
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser
    • A61F2009/00885Methods or devices for eye surgery using laser for treating a particular disease
    • A61F2009/00891Glaucoma

Definitions

  • the invention relates to the technical field of ophthalmic medical devices, in particular to a corneal path one-way aqueous humor drainage device.
  • Glaucoma is the second leading cause of irreversible blindness worldwide. According to statistics, there are about 60.5 million glaucoma patients in the world, and 8.4 million people who are blind in both eyes. The direct cost of glaucoma treatment in the United States reaches 2.9 billion U.S. dollars every year. At present, there is no statistics on the cost of glaucoma treatment in my country, but since the number of glaucoma patients in my country is 5-6 times that of the United States, if we treat all glaucoma patients, it is estimated that the direct cost of glaucoma treatment in my country can reach 15-18 billion US dollars, Indirect economic losses from glaucoma may be even greater.
  • the current mainstream MIGS procedures and products can be divided into three types: (1) increasing the outflow of aqueous humor through the trabecular meshwork; (2) drainage of aqueous humor in the suprachoroidal cavity; (3) ) Subconjunctival aqueous humor drainage.
  • the aqueous humor drainage of (1) and (2) MIGS surgical products mainly rely on the original physiological aqueous humor outflow channel, and the reduction in intraocular pressure is smaller than that of traditional trabeculectomy, which is suitable for patients with early and middle stages of open-angle glaucoma.
  • the advantages are Little effect on the conjunctiva.
  • (3) The mechanism of action of MIGS surgical products is similar to that of traditional trabeculectomy, and the magnitude of intraocular pressure reduction is also similar. The advantage is that the incidence of postoperative complications is lower than that of trabeculectomy.
  • iStent which was approved by the FDA in 2012 and is suitable for glaucoma patients with a mild course of disease. Its 1-year effective rate is 33.7%, and the disadvantage is the filtering channel. Easy to block.
  • iStent inject W which is approved by FDA in 2020, but there is no relevant literature report; Hydrus, approved by FDA in 2018, with a 1-year effective rate of 37.1%; iStent inject, approved by CE in 2010 , the 2-year effective rate was 31.0%; CyPass Micro-Stent was withdrawn from the market in 2018, and its disadvantages were the high risk of low intraocular pressure and obstruction of the filtration channel; SOLX gold shunt, listed in Canada, the 5-year effective rate was 35.8%; STARfloTM Glaucoma Implant CE approved in 2012, 2-year effective rate is 38.5%; MINIjectTM, CE approved in 2020, 6-month effective rate is 39.1%.
  • Drainage to the subconjunctiva includes XEN Gel Stent, which was approved by FDA in 2016.
  • the disadvantage is conjunctival scarring, and the 1-year effective rate is 36.3%.
  • the current common disadvantages of MIGS devices are filtration channel obstruction, fibrosis, displacement of drainage devices, and conjunctival scarring.
  • the embodiment of the present invention provides a corneal path unidirectional aqueous humor drainage device, which is used to solve the problems existing in the prior art.
  • the present invention adopts the following technical solutions.
  • a corneal path one-way aqueous humor drainage device has a Tesla valve unit group inside, and the Tesla valve unit group is configured as a drainage channel; the drainage channel is a one-way drainage, used to drain The aqueous humor in the eye drains to the ocular surface.
  • a base body is included, the base body has a first side portion and a second side portion connected to each other, and a Tesla valve unit group; one end of the first side portion has a liquid inlet, and one end of the second side portion has a liquid outlet,
  • the Tesla valve unit group runs through the first side and the second side, and communicates with the liquid inlet and the liquid outlet; when the liquid flows into the Tesla valve unit group from the liquid outlet, the Tesla valve unit group can block The liquid flows to the liquid inlet.
  • the Tesla valve unit group includes a plurality of Tesla valve units connected in series, and each Tesla valve unit includes a first channel and a second channel located on a radial side of the first channel; the second channel It includes a second liquid inlet and a second liquid outlet that communicate with each other, one end of the second liquid inlet and the second liquid outlet are respectively connected to the first channel, and the area where the second liquid inlet is connected to the first channel is configured as a special The liquid inlet end of the Tesla valve unit, the area where the second liquid outlet is connected to the first passage is configured as the liquid outlet of the Tesla valve unit, and the second liquid inlet and the second liquid outlet are respectively connected to the first passage.
  • the angle between the second liquid inlet and the first channel is greater than the angle between the second liquid outlet and the first channel, when the liquid enters the Tesla valve unit from the liquid outlet and flows out from the second liquid inlet
  • the liquid can block the flow of the liquid in the first channel.
  • the first channels of adjacent Tesla valve units have mutually overlapping sections, and in the adjacent Tesla valve units, the liquid outlet of one Tesla valve unit and the other Tesla valve unit
  • the liquid inlet ends of the pull valve units are respectively located on both sides of the section; the second channels of the adjacent Tesla valve units are opposite to each other.
  • the first channel of each Tesla valve unit includes a first liquid inlet and a first liquid outlet that communicate with each other; the first liquid inlet and the first liquid outlet of each Tesla valve unit are connected to each other has an included angle;
  • the first liquid outlet of one Tesla valve unit coincides with the first liquid inlet of another Tesla valve unit; the second outlet of one Tesla valve unit
  • the inclination angle of the liquid part is the same as the inclination angle of the first liquid inlet part of another Tesla valve unit.
  • the length of the base body is 1.0mm-6.0mm, the thickness is 0.05mm-0.5mm; the diameters of the liquid inlet and the liquid outlet are 0.01mm-0.09mm.
  • the length of the base body is 3.0mm-4.0mm, the thickness is 0.15mm-0.3mm; the diameters of the liquid inlet and the liquid outlet are 0.02mm-0.06mm.
  • the diameter of the drainage channel is 0.01mm-0.09mm.
  • the outer side wall has an auxiliary fixing structure for preventing the axial movement of the one-way aqueous humor drainage device of the corneal path.
  • the auxiliary fixing structure includes: a plurality of radially protruding fixing parts on both radial sides of the second side part; a plurality of fixing parts are arranged in sequence along the axial direction of the base body, and the length of the fixing parts located on the side part of the base body is longer than The length of the fixing part located in the middle of the base body makes the base body form a barb-shaped structure.
  • biocompatible materials are used.
  • the biocompatible material is a photocurable biocompatible material.
  • the photocurable biocompatible materials include epoxy resin (meth)acrylate materials, polyester (meth)acrylate materials, polyurethane (meth)acrylate materials, (meth)acrylate Any one of monomer-like and (meth)acrylate-modified natural biomaterials.
  • the photocurable biocompatible material includes triethoxylated bisphenol A dimethacrylate, bisphenol A epoxy methacrylate, polyethylene glycol di(meth)acrylate, (meth)acrylic acid Either of ester-modified gelatin and (meth)acrylate-modified hyaluronic acid.
  • the present invention provides a corneal path one-way aqueous humor drainage device, in which a Tesla valve unit group drainage channel is formed for drainage of aqueous humor to On the ocular surface, the drainage channel is one-way drainage.
  • the aqueous humor drainage device provided by the utility model introduces a Tesla valve as a structure to prevent the backflow of aqueous humor. When the liquid flows into the Tesla valve unit group from the liquid outlet, the Tesla valve unit group can block the liquid from entering the liquid Mouth flowing.
  • the aqueous humor drainage device provided by the utility model also has the following advantages: it can be used for glaucoma patients to reduce intraocular pressure, and can also be used for severe dry eye; it is made of good biocompatibility materials, and the drainage efficiency is high in clinical practice; the structure Compact, convenient for 3D printing modeling and molding, low cost and easy to use.
  • Fig. 1 is the front view of a kind of corneal path unidirectional aqueous humor drainage device provided by the present invention
  • Fig. 2 is the sectional view of Fig. 1;
  • Fig. 3 is the bottom view of Fig. 1;
  • Fig. 4 is the left view of Fig. 1;
  • Fig. 5 is the right view of Fig. 1;
  • Fig. 6 is a schematic structural diagram of the Tesla valve unit group in a corneal path one-way aqueous humor drainage device provided by the present invention
  • Fig. 7 is a schematic diagram of another preferred embodiment of a corneal path unidirectional aqueous humor drainage device provided by the present invention.
  • Fig. 8 is a schematic diagram of a drainage experiment of a corneal path unidirectional aqueous humor drainage device in isolated porcine eye tissue provided by the present invention
  • Fig. 9 is a schematic diagram of a safety experiment of a corneal path unidirectional aqueous humor drainage device provided by the present invention in living rabbit eye tissue.
  • Tesla valve unit group 21 First channel 211. First liquid inlet 212. First liquid outlet 22. Second channel 221. Second liquid inlet 222. Second liquid outlet 23. Inlet Terminal 24. Outlet terminal.
  • the invention provides an aqueous humor drainage device for treating glaucoma, which is used to solve the following technical problems in the prior art: some existing aqueous humor drainage devices cannot effectively prevent aqueous humor backflow, which affects the therapeutic effect; Although some aqueous humor drainage devices are equipped with one-way valves, the check effect is limited due to the small volume of the devices, and some drainage devices are drained through extracorporeal devices, which is inconvenient to use.
  • the present invention provides a corneal path one-way drainage device for aqueous humor, which has a Tesla valve unit group inside, and the Tesla valve unit group is configured as a drainage channel, and the drainage channel is a one-way drainage, that is, it can The aqueous humor in the eye drains to the ocular surface, and it can also prevent the aqueous humor on the ocular surface from backflowing.
  • the aqueous humor diverter includes a base body 1, the base body 1 has a first side 11 and a second side 12 integrally connected to each other, and a Tesla valve unit group 2.
  • the aqueous humor diverter is wedged into the eye through the first side part 11 , the first side part 11 has a liquid inlet 13 at one end, and the second side part 12 has a liquid outlet 14 at one end.
  • the Tesla valve unit group 2 runs through the first side part 11 and the second side part 12 , and communicates with the liquid inlet 13 and the liquid outlet 14 .
  • the Tesla valve unit group 2 is used to prevent the aqueous humor from flowing backward (that is, from the liquid outlet 14 to the liquid inlet 13), when the liquid flows into the Tesla valve unit group from the liquid outlet 14 2, the Tesla valve unit group 2 can block the flow of liquid to the liquid inlet 13.
  • the Tesla valve unit group 2 includes a plurality of Tesla valve units connected in series, and each Tesla valve unit includes a first channel 21 and is located in the radial direction of the first channel 21.
  • the second channel 22 on one side.
  • the second channel 22 includes a second liquid inlet part 221 and a second liquid outlet part 222 which communicate with each other.
  • One end of the second liquid inlet part 221 and the second liquid outlet part 222 are respectively connected to the first channel 21, and the second liquid inlet part 222 is connected to the first channel 21 respectively.
  • the area where the part 221 connects the first channel 21 (for example, as shown in FIG.
  • the ends of the two is configured as the liquid inlet 23 of the Tesla valve unit, and the second liquid outlet part 222 is connected to the first channel 21.
  • the region of is configured as the liquid outlet 24 of the Tesla valve unit.
  • the second liquid inlet part 221 has an included angle with the first channel 21
  • the second liquid outlet part 222 has an included angle with the first channel 21
  • the angle between the second liquid inlet part 221 and the first channel 21 is larger than that of the first channel 21.
  • the angle between the second liquid outlet portion 222 and the first channel 21 is, for example, the second liquid inlet portion 221 and the first channel 21 are nearly perpendicular to each other.
  • the first passages 21 of adjacent Tesla valve units have overlapping sections. (i.e. partial overlap).
  • the second channels 22 of the two Tesla valve units are respectively arranged on the radial sides of the first channel 21 to form mutually opposite settings; one Tesla valve unit
  • the liquid outlet 24 of the valve unit and the liquid inlet 23 of another Tesla valve unit are respectively located at the two ends of the section of the first channel 21 where they overlap each other.
  • each Tesla valve unit includes a first liquid inlet 211 and a first liquid outlet 212 that communicate with each other; the first liquid inlet 211 and the first liquid outlet of each Tesla valve unit The liquid outlets 212 have an included angle with each other. As shown in FIGS. 2 and 6 , when a plurality of Tesla valve units are connected in series, the middle channel part composed of the first channel 21 is in a zigzag shape as a whole.
  • a Tesla valve located in front
  • the first liquid outlet 212 of the unit coincides with the first liquid inlet 211 of another Tesla valve unit at the rear;
  • the inclination angle of the second liquid outlet 222 of one Tesla valve unit is the same as that of the other Tesla valve unit
  • the inclination angles of the first liquid inlet portion 211 of the pull valve unit are the same.
  • the second liquid outlet 222 of a Tesla valve unit at the front directly communicates with the first liquid outlet 212 of another Tesla valve unit at the rear, and the two are inclined.
  • the angles are the same, forming a straight channel as a whole, which can reduce the resistance of the forward flow of liquid and help to discharge the aqueous humor.
  • FIGS. 2 and 6 show the optimal form of a Tesla valve unit group 2: the first liquid inlet portion 211 and the first liquid outlet portion 212 of each Tesla valve unit have an included angle with each other, and each Tesla valve unit
  • the absolute values of the inclination angles of the first liquid inlet part 211 and the first liquid outlet part 212 of the pull valve unit are the same, and the directions are opposite.
  • the first liquid outlet 212 of the unit coincides with the first liquid inlet 211 of another Tesla valve unit located at the rear, and the second liquid outlet 222 of a Tesla valve unit located at the front directly communicates with the other one at the rear.
  • the first liquid outlet portion 212 of a Tesla valve unit, and the two inclination angles are the same, forming a straight line channel as a whole; the second liquid inlet portion 221 of the second channel 22 of each Tesla valve unit is connected to the second The length of the liquid outlet 222 is the same, and the inclination angle (orientation angle) is also the same.
  • the second liquid inlet 221 of each Tesla valve unit is perpendicular to the first liquid inlet 211, and the second liquid inlet 211 of each Tesla valve unit is perpendicular to each other.
  • the connection area between the second liquid inlet part 221 and the second liquid outlet part 222 is an arc-shaped bending structure.
  • the two adjacent Tesla valve units form a mirror-symmetrical configuration with the coincident first channel 21 as the axis, which is convenient for production and processing. For example, when using 3D printing technology, everything from modeling to printing It is more convenient and can effectively improve production efficiency.
  • the axial length of the substrate 1 is set to 1.0mm-6.0mm, preferably 3.0mm-4.0mm, the thickness is 0.05mm-0.5mm, preferably 0.15mm-0.3mm, the liquid inlet 13 and the outlet
  • the caliber of the liquid port 14 is 0.01 mm to 0.09 mm, preferably 0.02 mm to 0.06 mm
  • the finished house water drainage device formed by 3D printing process can meet the requirements of structural strength and printing accuracy at the same time.
  • the diameter of the drainage channel ranges from 0.01mm to 0.09mm, preferably 0.02mm to 0.06mm.
  • the aqueous humor drainage device adopts a barb-like shape, one side of which is a trapezoidal structure whose diameter gradually decreases towards its own end, and the end surface of the side end is arc-shaped noodle.
  • the other side has a radially protruding auxiliary fixing structure, which is used to prevent the axial movement of the one-way aqueous humor drainage device of the corneal path.
  • the first side portion 11 is approximately trapezoidal in shape, and the end face with the liquid inlet 13 is an arc-shaped surface, which is convenient for the drainage device to be wedged into the eye .
  • the auxiliary fixing structure includes: the second side part 12 is provided with a plurality of radially protruding fixing parts 15 on both radial sides thereof, which can prevent the drainage device from sliding in the eye.
  • the plurality of fixing parts 15 are arranged in sequence along the axial direction of the base body, and the length of the fixing parts 15 located at the side of the base body 1 (that is, adjacent to the liquid outlet 14 of the second side part 12) is longer than that located at the middle part of the base body 1 (the first side part 11 The length of the fixing part 15 of the area connected to the second side part 12).
  • the aqueous humor diverter as a whole forms an approximately barb-shaped structure.
  • the auxiliary fixing structure is a recessed part (not shown in the figure), and the specific arrangement is similar to the above-mentioned fixing part 15, and protrusions with anchoring functions are formed between adjacent recessed parts.
  • the above-mentioned fixing part 15 is preferably a convex ring, a convex point, a convex rib, a protruding piece or a thread protrusion, and the concave part is preferably a concave point, a groove or a concave thread structure.
  • the aqueous humor drainage device adopts a configuration in which one axial end is arc-shaped and the other end is a plane. It may also be configured in which both ends are arc-shaped as shown in FIG. 7 .
  • the aqueous humor drainage device is made of a biocompatible material, preferably a light-cured biocompatible material that can be used in a 3D printing process.
  • a biocompatible material preferably a light-cured biocompatible material that can be used in a 3D printing process.
  • epoxy resin (meth)acrylate materials preferably a light-cured biocompatible material that can be used in a 3D printing process.
  • epoxy resin (meth)acrylate materials preferably a light-cured biocompatible material that can be used in a 3D printing process.
  • polyester (meth)acrylate materials polyester (meth)acrylate materials, polyurethane (meth)acrylate materials, (meth)acrylate monomers and (meth)acrylic acid Any of ester-modified natural biomaterials.
  • Preferred are triethoxylated bisphenol A dimethacrylate, bisphenol A epoxy methacrylate, polyethylene glycol di(meth)acrylate, (meth)acrylate modified gelatin, (meth) Any of acrylate-
  • Fig. 8 is a schematic diagram of the drainage experiment of the corneal path unidirectional aqueous humor drainage device provided by the present invention in the isolated porcine eye tissue.
  • the Tesla valve unit set in the aqueous humor diverter can effectively prevent the dyeing liquid from flowing from the second side to the first side 11 .
  • Figure 9 is a schematic diagram of the safety experiment of the corneal path one-way aqueous humor drainage device provided by the present invention in the living rabbit eye tissue, and the figure shows the state of the 4th day after the aqueous humor drainage device is implanted into the rabbit eye tissue, where the figure a is the state of rabbit No. 1, and picture b is the state of rabbit No. 2. It can be seen from the figure that there is no allergic or inflammatory reaction in the eye tissues of the two rabbits, and the safety of the aqueous humor drainage device is good.
  • the present invention provides a corneal one-way drainage device for aqueous humor, in which a Tesla valve unit group drainage channel is formed for drainage of aqueous humor to the ocular surface, and the drainage channel is one-way drainage.
  • the aqueous humor drainage device provided by the utility model introduces a Tesla valve as a structure to prevent the backflow of aqueous humor.
  • the Tesla valve unit group can block the liquid from entering the liquid Mouth flowing.
  • the aqueous humor drainage device provided by the utility model also has the following advantages: it can be used for glaucoma patients to reduce intraocular pressure, and can also be used for severe dry eye; it is made of good biocompatibility materials, and the drainage efficiency is high in clinical practice; the structure Compact, convenient for 3D printing modeling and molding, low cost and easy to use.
  • each embodiment in this specification is described in a progressive manner, the same and similar parts of each embodiment can be referred to each other, and each embodiment focuses on the differences from other embodiments.
  • the description is relatively simple, and for relevant parts, please refer to part of the description of the method embodiments.
  • the device and system embodiments described above are only illustrative, and the units described as separate components may or may not be physically separated, and the components shown as units may or may not be physical units, that is, It can be located in one place, or it can be distributed to multiple network elements. Part or all of the modules can be selected according to actual needs to achieve the purpose of the solution of this embodiment. It can be understood and implemented by those skilled in the art without creative effort.

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Abstract

本发明提供的一种角膜路径单向房水引流器,其内形成有特斯拉阀单元组引流通道,用于将房水引流至眼表,引流通道为单向引流。本实用新型提供的房水引流器,引入特斯拉阀作为防止房水倒流的结构,当液体从出液口流入特斯拉阀单元组时,特斯拉阀单元组能够阻挡液体向进液口流动。本实用新型提供的房水引流器还具有如下优点:既可以用于青光眼患者降低眼压,还可以用于重症干眼;由生物相容性良好的材料制成,临床上引流效率高;结构紧凑、便于3D打印的建模与成型,成本低廉使用方便的优点。

Description

一种角膜路径单向房水引流器 技术领域
本发明涉及眼科医疗器械技术领域,尤其涉及一种角膜路径单向房水引流器。
背景技术
青光眼是全球第二位不可逆致盲性眼病。据统计,全球青光眼患者约6050万,双眼盲者840万,美国每年因青光眼治疗的直接费用达29亿美元。我国目前尚无关于青光眼治疗的花费统计,但由于我国青光眼患者数量为美国的5-6倍,如果我们对所有青光眼患者都进行治疗,估计我国青光眼治疗的直接花费可达150-180亿美元,由青光眼造成的间接经济损失可能更大。更为严重的是,随着人口的老龄化,截止到2020年,青光眼患者已增至7964万,1120万人可能因青光眼发展为双眼盲。2022年“十四五”更是首次提出加强重点人群重点眼病防治,明确指出要提高青光眼的早诊早治能力,随着人口老龄化加速、国民健康意识攀升,未来青光眼诊疗市场增长潜力巨大。因此,对于青光眼的防治研究具有非常重要的社会和经济意义。
现阶段国内的青光眼临床治疗主要手段为药物治疗和手术治疗。前期多用药物(眼药水)干预治疗,后期则多通过始于1968年的“金标准”手术“小梁网切除术”治疗。目前,所有的治疗手段均是以在患者全生命周期中,通过合理有效方式来控制眼压、保有视力为目的。以上两种治疗干预方式沿用多年,对药物治疗手段会出现诸如药物效果漂移,患者依从性差,终生用药,药物不良反应等弊端;对青光眼手术目前治疗的“金标准”小梁网切除术,则存在医生学习曲线长、手术创伤较大、对眼正常结构及机能破坏大、并发症复杂等诸多问题。
针对这些痛点问题,该领域的专家、学者、企业一直在探索尝试,希望寻找并发症发生率更低、创伤更小的替代手术方式。近年来,在国际上趋于流行和经过百万人次以上验证的新一代MIGS手术正越来越受到大家的关注。其凭借手术创口小、手术操作时间短、术后恢复快、医生学习曲线低等优点,越来越受到广大眼科医生的重视。据了解,目前新一代MIGS作为青光眼治疗的新兴手段和流行趋势,已在国际上大规模展开应用。从2018年至今的4年时间内,全球共有超过百万的青光眼患者进行了MIGS术式的干预和治疗。
依据降低眼内压(IOP)的原理,目前主流的MIGS术式和产品可分为三种类型: (1)增加小梁网途径房水流出;(2)脉络膜上腔房水引流;(3)结膜下房水引流。其中,(1)和(2)MIGS术式产品的房水引流主要借助原生理房水流出通路,其降眼压幅度小于传统小梁切除术,适用于开角型青光眼早中期患者,优点是对结膜影响较小。(3)中MIGS术式产品的作用机制与传统小梁切除术相似,降眼压幅度也相似,优势是术后并发症发生率小于小梁网切除术。
目前已问世的MIGS手术中,其中利用小梁网schlemm’s管通路的有:iStent,2012年FDA获批,适用于病程较轻的青光眼患者,其1年有效率为33.7%,缺点为滤过通道易阻塞。利用睫状体脉络膜上腔通路的有iStent inject W,2020年FDA获批,目前没有相关文献报道;Hydrus,2018年FDA获批,1年有效率为37.1%;iStent inject,2010年CE获批,2年有效率为31.0%;CyPass Micro-Stent2018年退出市场,其缺点是低眼压风险高及滤过通道阻塞;SOLX gold shunt,在加拿大上市,5年有效率为35.8%;STARfloTM Glaucoma Implant 2012年CE获批,2年有效率为38.5%;MINIjectTM,2020年CE获批,6个月有效率39.1%。引流至结膜下的有XEN Gel Stent,2016年FDA获批,缺点是结膜瘢痕化,1年有效率36.3%;PRESERFLOTM MicroShunt,2012年CE获批,缺点是结膜瘢痕化,5年有效率46.7%。综上,目前常见的MIGS器械缺点是滤过通道阻塞,纤维化,引流装置移位,结膜瘢痕化等。
综合来看,不同产品都有各自的特点与不同的适应症范围。近期还国外有文献报道了一种外眼操作的青光眼引流器,能直接将房水引流到角膜外,降眼压效果显著,并且对重症干眼症会有效果。从入路方式来看,外眼植入手术操作简单方便,并且直接将房水引流到眼表,对重症干眼会有效果,是一种综合优势明显且有广泛应用前景的房水引流器。
发明内容
本发明的实施例提供了一种角膜路径单向房水引流器,用于解决现有技术中存在的问题。
为了实现上述目的,本发明采取了如下技术方案。
一种角膜路径单向房水引流器,角膜路径单向房水引流器内部具有特斯拉阀单元组,特斯拉阀单元组被构造为引流通道;引流通道为单向引流,用于将眼内的房水引流至眼表。
优选地,包括基体,该基体具有相互连接的第一侧部和第二侧部,以及特斯拉阀单元组;第一侧部一端具有进液口,第二侧部一端具有出液口,特斯拉阀单元组贯穿 第一侧部和第二侧部,并连通进液口和出液口;当液体从出液口流入特斯拉阀单元组时,特斯拉阀单元组能够阻挡液体向进液口流动。
优选地,特斯拉阀单元组包括多个相互串联的特斯拉阀单元,每个特斯拉阀单元包括第一通道和位于该第一通道径向一侧的第二通道;第二通道包括相互连通的第二进液部和第二出液部,第二进液部和第二出液部的一端分别连接第一通道,第二进液部连接第一通道的区域被构造成特斯拉阀单元的进液端,第二出液部连接第一通道的区域被构造成特斯拉阀单元的出液端,第二进液部和第二出液部分别与第一通道具有夹角,并且第二进液部与第一通道的夹角大于第二出液部与第一通道的夹角,当液体从出液端进入特斯拉阀单元,从第二进液部流出的液体能够阻挡第一通道内液体的流动。
优选地,相邻接的特斯拉阀单元的第一通道具有相互重合的区段,该相邻接的特斯拉阀单元中,一个特斯拉阀单元的出液端和另一个特斯拉阀单元的进液端分别位于该区段的两侧;该相邻接的特斯拉阀单元的第二通道相互对置。
优选地,每个特斯拉阀单元的第一通道包括相互连通的第一进液部和第一出液部;每个特斯拉阀单元的第一进液部和第一出液部相互具有夹角;
相邻接的特斯拉阀单元中:一个特斯拉阀单元的第一出液部与另一个特斯拉阀单元的第一进液部相重合;一个特斯拉阀单元的第二出液部的倾斜角度与另一个特斯拉阀单元的第一进液部的倾斜角度相同。
优选地,基体的长度为1.0mm~6.0mm,厚度为0.05mm~0.5mm;进液口和出液口的口径为0.01mm~0.09mm。
优选地,基体的长度为3.0mm~4.0mm,厚度为0.15mm~0.3mm;进液口和出液口的口径为0.02mm~0.06mm。
优选地,引流通道的直径为0.01mm~0.09mm。
优选地,外侧壁具有辅助固定结构,用于防止角膜路径单向房水引流器轴向移动。
优选地,辅助固定结构包括:第二侧部的径向两侧具有多个径向凸起的固定部;多个固定部沿基体轴向依次布置,并且位于基体侧部的固定部的长度大于位于基体中部的固定部的长度,使基体构成倒钩型结构。
优选地,采用生物相容性材料。
优选地,生物相容性材料为光固化生物相容性材料。
优选地,光固化生物相容性材料包括环氧树脂(甲基)丙烯酸酯类材料、聚酯(甲 基)丙烯酸酯类材料、聚氨酯(甲基)丙烯酸酯类材料、(甲基)丙烯酸酯类单体和(甲基)丙烯酸酯改性天然生物材料的任一一种。
优选地,光固化生物相容性材料包括三乙氧化双酚A二甲基丙烯酸酯、双酚A环氧甲基丙烯酸酯、聚乙二醇二(甲基)丙烯酸酯、(甲基)丙烯酸酯改性明胶、(甲基)丙烯酸酯改性透明质酸的任一一种。
由上述本发明的实施例提供的技术方案可以看出,本发明提供的一种角膜路径单向房水引流器,其内形成有特斯拉阀单元组引流通道,用于将房水引流至眼表,引流通道为单向引流。本实用新型提供的房水引流器,引入特斯拉阀作为防止房水倒流的结构,当液体从出液口流入特斯拉阀单元组时,特斯拉阀单元组能够阻挡液体向进液口流动。本实用新型提供的房水引流器还具有如下优点:既可以用于青光眼患者降低眼压,还可以用于重症干眼;由生物相容性良好的材料制成,临床上引流效率高;结构紧凑、便于3D打印的建模与成型,成本低廉使用方便的优点。
本发明附加的方面和优点将在下面的描述中部分给出,这些将从下面的描述中变得明显,或通过本发明的实践了解到。
附图说明
为了更清楚地说明本发明实施例的技术方案,下面将对实施例描述中所需要使用的附图作简单地介绍,显而易见地,下面描述中的附图仅仅是本发明的一些实施例,对于本领域普通技术人员来讲,在不付出创造性劳动的前提下,还可以根据这些附图获得其他的附图。
图1为本发明提供的一种角膜路径单向房水引流器的主视图;
图2为图1的剖视图;
图3为图1的仰视图;
图4为图1的左视图;
图5为图1的右视图;
图6为本发明提供的一种角膜路径单向房水引流器中特斯拉阀单元组结构示意图;
图7为本发明提供的一种角膜路径单向房水引流器另一种优选实施例的示意图;
图8为本发明提供的一种角膜路径单向房水引流器在离体猪眼组织内的引流实验示意图;
图9为本发明提供的一种角膜路径单向房水引流器在活体兔眼组织内的安全性实验示意图。
图中:
1.基体 11.第一侧部 12.第二侧部 13.进液口 14.出液口 15.固定部;
2.特斯拉阀单元组 21.第一通道 211.第一进液部 212.第一出液部 22.第二通道 221.第二进液部 222.第二出液部 23.进液端 24.出液端。
具体实施方式
下面详细描述本发明的实施方式,所述实施方式的示例在附图中示出,其中自始至终相同或类似的标号表示相同或类似的元件或具有相同或类似功能的元件。下面通过参考附图描述的实施方式是示例性的,仅用于解释本发明,而不能解释为对本发明的限制。
本技术领域技术人员可以理解,除非特意声明,这里使用的单数形式“一”、“一个”、“所述”和“该”也可包括复数形式。应该进一步理解的是,本发明的说明书中使用的措辞“包括”是指存在所述特征、整数、步骤、操作、元件和/或组件,但是并不排除存在或添加一个或多个其他特征、整数、步骤、操作、元件、组件和/或它们的组。应该理解,当我们称元件被“连接”或“耦接”到另一元件时,它可以直接连接或耦接到其他元件,或者也可以存在中间元件。此外,这里使用的“连接”或“耦接”可以包括无线连接或耦接。这里使用的措辞“和/或”包括一个或更多个相关联的列出项的任一单元和全部组合。
本技术领域技术人员可以理解,除非另外定义,这里使用的所有术语(包括技术术语和科学术语)具有与本发明所属领域中的普通技术人员的一般理解相同的意义。还应该理解的是,诸如通用字典中定义的那些术语应该被理解为具有与现有技术的上下文中的意义一致的意义,并且除非像这里一样定义,不会用理想化或过于正式的含义来解释。
为便于对本发明实施例的理解,下面将结合附图以几个具体实施例为例做进一步的解释说明,且各个实施例并不构成对本发明实施例的限定。
本发明提供一种用于青光眼治疗的房水引流器,用于解决现有技术中存在的如下 技术问题:现有的一些房水引流装置不能够有效防止房水倒流,影响了治疗效果;另一些房水引流装置虽然设置了单向阀,但是受限于装置的微小体积,止回效果有限,部分引流器通过体外装置进行引流,使用不便。
本发明提供的一种角膜路径单向房水引流器,其内部具有特斯拉阀单元组,所述特斯拉阀单元组被构造为引流通道,该引流通道为单向引流,即能够将眼内的房水引流至眼表,还能够防止眼表的房水倒流。
在本发明提供的优选实施例中,参见图1至7,本房水引流器包括基体1,基体1具有相互一体成型连接的第一侧部11和第二侧部12,以及特斯拉阀单元组2。房水引流器通过第一侧部11楔入眼部,该第一侧部11一端具有进液口13,第二侧部12一端具有出液口14。特斯拉阀单元组2贯穿第一侧部11和第二侧部12,并连通进液口13和出液口14。在本发明提供的实施例中,特斯拉阀单元组2用于防止房水倒流(即从出液口14流向进液口13),当液体从出液口14流入特斯拉阀单元组2时,特斯拉阀单元组2能够阻挡液体向进液口13流动。
在本发明提供的优选实施例中,特斯拉阀单元组2包括多个相互串联的特斯拉阀单元,每个特斯拉阀单元包括第一通道21和位于该第一通道21径向一侧的第二通道22。其中,第二通道22包括相互连通的第二进液部221和第二出液部222,第二进液部221和第二出液部222的一端分别连接第一通道21,第二进液部221连接第一通道21的区域(例如图6中所示即二者的端部)被构造成该个特斯拉阀单元的进液端23,第二出液部222连接第一通道21的区域被构造成该个特斯拉阀单元的出液端24。第二进液部221与第一通道21具有夹角,第二出液部222与第一通道21也具有夹角,并且第二进液部221与第一通道21的夹角的角度大于第二出液部222与第一通道21的夹角的角度,例如第二进液部221与第一通道21接近相互垂直。具有上述设置的特斯拉阀单元,当液体从出液端24倒流进入其中时,一部分沿第一通道21向出液端24流动,另一路沿第二通道22向出液端24流动,当两路液体在出液端24交汇时,由于第二进液部221与第一通道21的夹角很陡,使得第二进液部221流出的液体能够形成对第一通道21流出液体的较大阻力,阻挡第一通道21内液体的流动。
为了在有限的空间内尽可能多的布置特斯拉阀单元,在一些改进实施例中,如图6所示,相邻接的特斯拉阀单元的第一通道21具有相互重合的区段(即为部分重合)。在每对相邻接的特斯拉阀单元中:两个特斯拉阀单元的第二通道22分别布置在第一 通道21的径向两侧,形成相互对置的设置;一个特斯拉阀单元的出液端24和另一个特斯拉阀单元的进液端23分别位于二者相互重合的第一通道21的区段的两端。通过上述设置,形成第二通道22错开布置、交错连接的布局,结构紧凑,具有较好的空间利用率。
进一步的,每个特斯拉阀单元的第一通道21包括相互连通的第一进液部211和第一出液部212;每个特斯拉阀单元的第一进液部211和第一出液部212相互具有夹角,如图2和6中所示的,当多个特斯拉阀单元相互串联后,由第一通道21组成的中间通道部整体呈折线型。
在此基础上,在一些改进实施例中,相邻接的特斯拉阀单元中:(以液体从进液端23至出液端24的正向为基准)位于前方的一个特斯拉阀单元的第一出液部212与位于后方的另一个特斯拉阀单元的第一进液部211相重合;一个特斯拉阀单元的第二出液部222的倾斜角度与另一个特斯拉阀单元的第一进液部211的倾斜角度相同。例如在图2和6中所示的,位于前方的一个特斯拉阀单元的第二出液部222直接连通后方的另一特斯拉阀单元的第一出液部212,并且二者倾斜角度相同,整体构成一直线型通道,能够减少液体正向流动的阻力,有助于排出房水。
在图2和6中显示了一个特斯拉阀单元组2最优形态:每个特斯拉阀单元的第一进液部211和第一出液部212相互具有夹角,每个特斯拉阀单元的第一进液部211和第一出液部212倾斜角度的绝对值相同,方向相反,由第一通道21组成的中间通道部整体呈折线型;位于前方的一个特斯拉阀单元的第一出液部212与位于后方的另一个特斯拉阀单元的第一进液部211相重合,位于前方的一个特斯拉阀单元的第二出液部222直接连通后方的另一特斯拉阀单元的第一出液部212,并且二者倾斜角度相同,整体构成一直线型通道;每个特斯拉阀单元的第二通道22的第二进液部221与第二出液部222的长度相同,倾斜角(方向角)也相同,每个特斯拉阀单元的第二进液部221与第一进液部211相互垂直,每个特斯拉阀单元的第二进液部221与第二出液部222的连接区域为弧形弯折结构。通过上述设置,使相邻的两个特斯拉阀单元形成以重合的第一通道21为轴,镜像对称的构型,其便于生产加工,例如使用3D打印工艺时,从建模到打印都较为便捷,能够有效提高生产效率。
申请人在试验中发现,将基体1的设置轴向长度为1.0mm~6.0mm,优选3.0mm~4.0mm,厚度为0.05mm~0.5mm,优选0.15mm~0.3mm,进液口13和出液口 14的口径为0.01mm~0.09mm,优选0.02mm~0.06mm时,使用3D打印工艺成型的本房水引流器成品能够同时满足结构强度与打印精度的要求。
在本发明提供的优选实施例中,引流通道直径的范围为0.01mm~0.09mm,优选0.02mm~0.06mm。
在本发明提供的优选实施例中,本房水引流器采用近似倒钩型的外形,其一侧为朝自身端部直径逐渐减小的近似梯形的构造,该侧端部的端面为弧形面。另一侧具有径向凸起的辅助固定结构,用于防止所述角膜路径单向房水引流器轴向移动。
具体的,如图1和2所示,在一种优选方式中,第一侧部11为近似梯形的构造,具有进液口13的端部端面为弧形面,便于引流器楔入眼部。辅助固定结构包括:第二侧部12在其径向两侧设置有多个径向凸起的固定部15,能够防止引流器在眼部滑动。该多个固定部15沿基体轴向依次布置,并且位于基体1侧部(即邻近第二侧部12的出液口14)的固定部15的长度大于位于基体1中部(第一侧部11与第二侧部12相连接的区域)的固定部15的长度。具有上述设置的第一侧部11与第二侧部12使房水引流器整体构成近似倒钩型的结构。
在另一种优选方式中,辅助固定结构为凹陷部(图中未示出),具体布置方式与上述固定部15类似,相邻凹陷部之间即形成具有锚固作用的凸起。
上述的固定部15优选为凸环、凸点、凸棱、凸片或螺纹凸起,凹陷部优选为凹点、凹槽或凹陷螺纹结构。
如图1所示,本房水引流器采用轴向一端弧形端面,另一端为平面的构型,也可以是如图7所示的,采用两端都是弧形端面的构型。
在本发明提供的优选实施例中,本房水引流器采用生物相容性材料,优选为可以用于3D打印工艺的光固化生物相容性材料。具体为环氧树脂(甲基)丙烯酸酯类材料、聚酯(甲基)丙烯酸酯类材料、聚氨酯(甲基)丙烯酸酯类材料、(甲基)丙烯酸酯类单体和(甲基)丙烯酸酯改性天然生物材料的任一一种。优选为三乙氧化双酚A二甲基丙烯酸酯、双酚A环氧甲基丙烯酸酯、聚乙二醇二(甲基)丙烯酸酯、(甲基)丙烯酸酯改性明胶、(甲基)丙烯酸酯改性透明质酸的任一一种。
图8为本发明提供的角膜路径单向房水引流器在离体猪眼组织内的引流实验示意图,可以看出,在楔入眼球组织的房水引流器的第二侧部12一侧滴定染色液体,房 水引流器内的特斯拉阀单元组能够有效地防止染色液体从第二侧部向第一侧部11流动。
图9为本发明提供的角膜路径单向房水引流器在活体兔眼组织内的安全性实验示意图,图中显示的是房水引流器植入兔眼组织后第4天的状态,其中图a为1号兔的状态,图b为2号兔的状态,由图中可以看出,两只兔的眼组织均未出现过敏与炎症反应,房水引流器的安全性良好。
综上所述,本发明提供的一种角膜路径单向房水引流器,其内形成有特斯拉阀单元组引流通道,用于将房水引流至眼表,引流通道为单向引流。本实用新型提供的房水引流器,引入特斯拉阀作为防止房水倒流的结构,当液体从出液口流入特斯拉阀单元组时,特斯拉阀单元组能够阻挡液体向进液口流动。本实用新型提供的房水引流器还具有如下优点:既可以用于青光眼患者降低眼压,还可以用于重症干眼;由生物相容性良好的材料制成,临床上引流效率高;结构紧凑、便于3D打印的建模与成型,成本低廉使用方便的优点。
本领域普通技术人员可以理解:附图只是一个实施例的示意图,附图中的模块或流程并不一定是实施本发明所必须的。
通过以上的实施方式的描述可知,本领域的技术人员可以清楚地了解到本发明可借助软件加必需的通用硬件平台的方式来实现。基于这样的理解,本发明的技术方案本质上或者说对现有技术做出贡献的部分可以以软件产品的形式体现出来,该计算机软件产品可以存储在存储介质中,如ROM/RAM、磁碟、光盘等,包括若干指令用以使得一台计算机设备(可以是个人计算机,服务器,或者网络设备等)执行本发明各个实施例或者实施例的某些部分所述的方法。
本说明书中的各个实施例均采用递进的方式描述,各个实施例之间相同相似的部分互相参见即可,每个实施例重点说明的都是与其他实施例的不同之处。尤其,对于装置或系统实施例而言,由于其基本相似于方法实施例,所以描述得比较简单,相关之处参见方法实施例的部分说明即可。以上所描述的装置及系统实施例仅仅是示意性的,其中所述作为分离部件说明的单元可以是或者也可以不是物理上分开的,作为单元显示的部件可以是或者也可以不是物理单元,即可以位于一个地方,或者也可以分布到多个网络单元上。可以根据实际的需要选择其中的部分或者全部模块来实现本实施例方案的目的。本领域普通技 术人员在不付出创造性劳动的情况下,即可以理解并实施。
以上所述,仅为本发明较佳的具体实施方式,但本发明的保护范围并不局限于此,任何熟悉本技术领域的技术人员在本发明揭露的技术范围内,可轻易想到的变化或替换,都应涵盖在本发明的保护范围之内。因此,本发明的保护范围应该以权利要求的保护范围为准。

Claims (14)

  1. 一种角膜路径单向房水引流器,其特征在于,所述角膜路径单向房水引流器内部具有特斯拉阀单元组,所述特斯拉阀单元组被构造为引流通道;所述引流通道为单向引流,用于将眼内的房水引流至眼表。
  2. 根据权利要求1所述的角膜路径单向房水引流器,其特征在于,包括基体,该基体具有相互连接的第一侧部和第二侧部,以及所述特斯拉阀单元组;所述第一侧部一端具有进液口,所述第二侧部一端具有出液口,所述特斯拉阀单元组贯穿所述第一侧部和第二侧部,并连通所述进液口和出液口;当液体从所述出液口流入所述特斯拉阀单元组时,所述特斯拉阀单元组能够阻挡液体向所述进液口流动。
  3. 根据权利要求1所述的角膜路径单向房水引流器,其特征在于,所述特斯拉阀单元组包括多个相互串联的特斯拉阀单元,每个所述特斯拉阀单元包括第一通道和位于该第一通道径向一侧的第二通道;所述第二通道包括相互连通的第二进液部和第二出液部,所述第二进液部和第二出液部的一端分别连接所述第一通道,所述第二进液部连接所述第一通道的区域被构造成所述特斯拉阀单元的进液端,所述第二出液部连接所述第一通道的区域被构造成所述特斯拉阀单元的出液端,所述第二进液部和第二出液部分别与所述第一通道具有夹角,并且所述第二进液部与所述第一通道的夹角大于所述第二出液部与所述第一通道的夹角,当液体从所述出液端进入所述特斯拉阀单元,从所述第二进液部流出的液体能够阻挡所述第一通道内液体的流动。
  4. 根据权利要求3所述的角膜路径单向房水引流器,其特征在于,相邻接的所述特斯拉阀单元的所述第一通道具有相互重合的区段,该相邻接的所述特斯拉阀单元中,一个所述特斯拉阀单元的出液端和另一个所述特斯拉阀单元的进液端分别位于该区段的两侧;该相邻接的所述特斯拉阀单元的所述第二通道相互对置。
  5. 根据权利要求3所述的角膜路径单向房水引流器,其特征在于,每个所述特斯拉阀单元的所述第一通道包括相互连通的第一进液部和第一出液部;每个所述特斯拉阀单元的所述第一进液部和第一出液部相互具有夹角;
    相邻接的所述特斯拉阀单元中:一个所述特斯拉阀单元的第一出液部与另一个所述特斯拉阀单元的第一进液部相重合;一个所述特斯拉阀单元的第二出液部的倾斜角度与另一个所述特斯拉阀单元的第一进液部的倾斜角度相同。
  6. 根据权利要求2至5任一所述的角膜路径单向房水引流器,其特征在于,所述 基体的长度为1.0mm~6.0mm,厚度为0.05mm~0.5mm;所述进液口和出液口的口径为0.01mm~0.09mm。
  7. 根据权利要求6所述的角膜路径单向房水引流器,其特征在于,所述基体的长度为3.0mm~4.0mm,厚度为0.15mm~0.3mm;所述进液口和出液口的口径为0.02mm~0.06mm。
  8. 根据权利要求1至5任一所述的角膜路径单向房水引流器,其特征在于,所述引流通道的直径为0.01mm~0.09mm。
  9. 根据权利要求2至5任一所述的角膜路径单向房水引流器,其特征在于,外侧壁具有辅助固定结构,用于防止所述角膜路径单向房水引流器轴向移动。
  10. 根据权利要求9所述的角膜路径单向房水引流器,其特征在于,所述辅助固定结构包括:所述第二侧部的径向两侧具有多个径向凸起的固定部;所述多个固定部沿所述基体轴向依次布置,并且位于所述基体侧部的所述固定部的长度大于位于所述基体中部的所述固定部的长度,使所述基体构成倒钩型结构。
  11. 根据权利要求1至5任一所述的角膜路径单向房水引流器,其特征在于,采用生物相容性材料。
  12. 根据权利要求11所述的角膜路径单向房水引流器,其特征在于,所述生物相容性材料为光固化生物相容性材料。
  13. 根据权利要求12所述的角膜路径单向房水引流器,其特征在于,所述光固化生物相容性材料包括环氧树脂(甲基)丙烯酸酯类材料、聚酯(甲基)丙烯酸酯类材料、聚氨酯(甲基)丙烯酸酯类材料、(甲基)丙烯酸酯类单体和(甲基)丙烯酸酯改性天然生物材料的任一一种。
  14. 根据权利要求13所述的角膜路径单向房水引流器,其特征在于,所述光固化生物相容性材料包括三乙氧化双酚A二甲基丙烯酸酯、双酚A环氧甲基丙烯酸酯、聚乙二醇二(甲基)丙烯酸酯、(甲基)丙烯酸酯改性明胶、(甲基)丙烯酸酯改性透明质酸的任一一种。
PCT/CN2022/138314 2022-02-16 2022-12-12 一种角膜路径单向房水引流器 WO2023155565A1 (zh)

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