Devices and methods for glaucoma treatment

• US 20040102729A1
• Filed: 08/05/2003
• Published: 05/27/2004
• Est. Priority Date: 04/08/2002
• Status: Active Grant

• Current Assignee: Glaukos Corporation
• Original Assignee: Glaukos Corporation
• Inventors: Smedley, Gregory T., Tu, Hosheng, Haffner, David
• Granted Patent: US 7,867,186 B2
• Time in Patent Office: Days
• US Class Current: 604/8
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2002/826 more than one stent being applied sequentially
• CPC Class Codes: A61F 2002/9505 having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
• CPC Class Codes: A61F 2002/9583 Means for holding the stent on the balloon, e.g. using protrusions, adhesives or an outer sleeve
• CPC Class Codes: A61F 2002/9665 with additional retaining means
• CPC Class Codes: A61F 9/0017 implantable in, or in contact with, the eye, e.g. ocular inserts
• CPC Class Codes: A61F 9/00781 Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment drainage implants in general A61M27/002

Abstract

Intraocular stents and applicators are disclosed for treating glaucoma. The stents are configured to extend between the anterior chamber of the eye and Schlemm'"'"'s canal for enhancing outflow of aqueous from the anterior chamber so as to reduce intraocular pressure. The stents can have features for anchoring the stent into Schlemm'"'"'s canal as well as preventing the walls of Schlemm'"'"'s canal from closing the outlet of the stents. The applicators can be steerable so as to make implantation easier. Additionally, the applicators can be configured to hold a plurality of stents so that multiple stents can be implanted through one incision without removing the applicator from the incision between serial implantations.

Claims

1. An implant for treating glaucoma, said implant having a longitudinal implant axis, and comprising:

an outflow portion through which said longitudinal implant axis passes, said outflow portion shaped and sized to be;

(a) introduced into Schlemm'"'"'s canal with said portion of said longitudinal implant axis at an angle to Schlemm'"'"'s canal; and

(b) received within Schlemm'"'"'s canal regardless of a rotational orientation of the outflow portion about said longitudinal implant axis during said introduction; and

an inflow portion configured to permit communication of fluid from the anterior chamber of the eye to the outflow portion.

13. The instrument of claim 1, wherein the actuator comprises a pusher member.

14. The instrument of claim 1, wherein the actuator comprises a rod or a tube.

2. An implant for treating glaucoma, comprising:

an outflow portion, sized and shaped to be received within Schlemm'"'"'s canal, said outflow portion comprising;

an outflow portion base having an outflow opening; and

at least one standoff member disposed to space said outflow opening from a wall of Schlemm'"'"'s canal, such that said outflow opening is unobstructed by said canal wall.

3. An implant for treating glaucoma, said implant having a longitudinal implant axis and comprising:

a first portion at a first end of said longitudinal implant axis, said first portion sized and configured to reside in Schlemm'"'"'s canal, such that said first portion has a maximum dimension along a longitudinal axis of Schlemm'"'"'s canal that is not substantially greater than a dimension of the first portion that runs perpendicular to both said longitudinal axis of Schlemm'"'"'s canal and to said longitudinal implant axis; and

a second portion at a second end of said longitudinal implant axis, said second portion configured to provide fluid communication between the anterior chamber and said first portion.

4. An implant for treating glaucoma, comprising:

an outflow portion, sized and shaped to be received within Schlemm'"'"'s canal;

an inflow portion in fluid communication with said outflow portion, the inflow portion configured to be disposed in the anterior chamber of the eye; and

a central portion extending between the inflow and outflow portions;

the outflow portion having a diameter that is no more than three times the diameter of the central portion.

5. An instrument for delivering implants for treating an ophthalmic condition, the instrument comprising:

an elongate body, said elongate body sized to be introduced into an eye through an incision in the eye;

a plurality of implants positioned in the elongate body; and

said elongate body further comprising an actuator that serially dispenses the implants from the elongate body for implanting in eye tissue.

6. The instrument of claim 5, wherein the elongate body comprises a tube.

7. The instrument of claim 5, wherein the implants are positioned end to end in the tube.

8. The instrument of claim 5, wherein the body comprises a cutting member.

9. The instrument of claim 5, wherein the body comprises a tube and the cutting member comprises an end of the tube.

10. The instrument of claim 5, wherein the body comprises a tube and the cutting member comprises a trocar in the tube.

11. The instrument of claim 10, wherein the implants have respective lumens and the trocar passes through the lumens.

12. The instrument of claim 10, wherein the instrument dispenses the implants through a wall of Schlemm'"'"'s canal, said trocar having a cutting edge sufficiently sharp to cut through said wall of Schlemm'"'"'s canal, but not so sharp as to significantly damage a scleral wall of Schlemm'"'"'s canal.

15. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location, without removing said instrument from the eye between said deliveries of said implants.

16. The method of claim 15, further comprising determining said locations with reference to morphological data on collector channel locations.

17. The method of claim 15, wherein the incision is a superiorly located limbal incision.

18. The method of claim 17, wherein the incision is between 10 o'"'"'clock and 2 o'"'"'clock.

19. The method of claim 15, further comprising performing cataract surgery through said incision.

20. The method of claim 15, further comprising determining said locations by imaging collector channel locations.

21. The method of claim 15, wherein said implants are delivered through a trabecular meshwork of said eye.

22. The method of claim 15, wherein said locations are angularly spaced along Schlemm'"'"'s canal by at least 20 degrees.

23. The method of claim 15, wherein the first and second locations are substantially at collector channels.

24. The method of claim 15, wherein said implants have different flow characteristics.

25. The method of claim 15, wherein one of said first and second locations is nasal and the other of said first and second locations is temporal.

26. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location;

wherein said locations are determined from morphological data on collector channel locations.

27. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location;

wherein said locations are determined by imaging collector channel locations.

28. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location;

wherein said locations are angularly spaced along Schlemm'"'"'s canal by at least 20 degrees.

29. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location;

wherein the first and second locations are substantially at collector channels.

30. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant through a wall of Schlemm'"'"'s canal at a first location; and

utilizing said instrument to deliver a second implant through a wall of Schlemm'"'"'s canal at a second location;

wherein said implants have different flow characteristics.

31. A method of implanting a plurality of implants for treating glaucoma, comprising:

inserting an instrument into an eye through an incision;

utilizing said instrument to deliver a first implant into the posterior segment of the eye; and

utilizing said instrument to deliver a second implant into the posterior segment of the eye at a second location, without removing said instrument from the eye between said deliveries of said implants.

32. A method of treating an eye condition, the method comprising:

serially dispensing a plurality of preloaded implants from an instrument into eye tissue at a respective plurality of locations within the eye.