GLAUCOMA SURGERY METHODS AND SYSTEMS

• US 20080082078A1
• Filed: 10/17/2007
• Published: 04/03/2008
• Est. Priority Date: 05/21/2001
• Status: Active Grant

• Current Assignee: EyeLight, Inc.
• Original Assignee: EyeLight, Inc.
• Inventors: Berlin, Michael
• Granted Patent: US 8,679,089 B2
• Time in Patent Office: Days
• US Class Current: 604/521
• CPC Class Codes: A61F 2009/00844 Feedback systems
• CPC Class Codes: A61F 2009/00868 Ciliary muscles or trabecular meshwork
• CPC Class Codes: A61F 2009/00891 Glaucoma
• 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
• CPC Class Codes: A61F 9/00802 for photoablation

Abstract

Methods and systems are disclosed for creating an aqueous flow pathway in the trabecular meshwork, juxtacanalicular trabecular meshwork and Schlemm'"'"'s canal of an eye for reducing elevated intraocular pressure. Some embodiments described apparatus and methods useful in photoablation of tissues. In some embodiments, a photoablation apparatus is used to perforate a tissue, forming an aperture into a space behind the tissue. Gases formed during a photoablation process can be used to pressurize the space behind the tissue to enhance patency of the space. In some embodiments the tissue is the trabecular meshwork of the eye and a wall of Schlemm'"'"'s canal, and the space behind the tissue is a portion of the lumen of Schlemm'"'"'s canal. In some embodiments, the method is useful in the treatment of glaucoma by improving outflow from the anterior chamber of the eye into Schlemm'"'"'s canal, reducing intraocular pressure.

Claims

1. A method, of treating glaucoma in an eye, the method comprising:

creating an aperture through a first layer of eye tissue at a target site located in an anterior portion of the eye;

advancing a distal portion of a delivery device through the first layer of eye tissue to a location between the first layer of eye tissue and a second layer of eye tissue, the location being within a space between the first layer and second layer of eye tissue, a distal opening of the delivery device being in fluid communication with the space between the first and second layers of eye tissue;

advancing, through the distal portion of the delivery device, a fluid comprising an angiostatic steroid toward the distal opening of the delivery device; and

administering, through the distal opening of the delivery device, the fluid into the space between the first and second layers of eye tissue;

wherein the administering of the fluid expands the space between the first and second layers of eye tissue as the first layer of eye tissue is further separated from the second layer of eye tissue by deposition of the fluid in the space; and

wherein the administering of the fluid is adapted to result in a lowered intraocular pressure in the eye.

2. The method of claim 1, wherein the space comprises a natural space.

3. The method of claim 1, wherein the lowered intraocular pressure is achieved by keeping the aperture open.

4. The method of claim 3, wherein the eye tissue comprises trabecular meshwork.

5. The method of claim 3, wherein the eye tissue comprises a wall of Schlemm'"'"'s canal.

6. The method of claim 1, wherein the lowered intraocular pressure is achieved by a pharmacological effect of the angiostatic steroid.

7. The method of claim 6, wherein the pharmacological effect comprises an anti-inflammatory effect.

8. The method of claim 1, wherein the lowered intraocular pressure is achieved by keeping an aperture in eye tissue open by a pharmacologic action of the angiostatic steroid.

9. The method of claim 1, wherein the angiostatic steroid comprises anecortave acetate.

10. The method of claim 1, wherein the fluid comprises a viscoelastic fluid.

11. The method of claim 1, wherein the fluid comprises molecules having a molecular size that is larger than a pore size of the first layer of eye tissue.

12. The method of claim 1, wherein creating the aperture comprises cutting the first layer of eye tissue with a cutting device.

13. The method of claim 1, wherein the fluid flows through the delivery device under positive pressure.

14. The method of claim 1, wherein the fluid is advanced through a fluid pathway coaxial with the delivery device.

15. The method of claim 1, further comprising:

advancing the distal portion of the delivery device through the anterior chamber of the eye toward the trabecular meshwork; and

creating the aperture in the trabecular meshwork.

16. The method of claim 1, wherein the first layer of eye tissue comprises the trabecular meshwork, the second layer of tissue comprises a portion of an outer wall of Schlemm'"'"'s canal, and the space comprises a portion of a lumen of Schlemm'"'"'s canal.

17. A method, of treating glaucoma in an eye, the method comprising:

creating an aperture through a first layer of eye tissue at a target site located in an anterior portion of the eye;

advancing a distal portion of a delivery device through the first layer of eye tissue to a location between the first layer of eye tissue and a second layer of eye tissue, the location being within a space between the first layer and second layer of eye tissue, a distal opening of the delivery device being in fluid communication with the space between the first and second layers of eye tissue;

advancing, through the distal portion of the delivery device, a fluid comprising an angiostatic steroid toward the distal opening of the delivery device; and

administering, through the distal opening of the delivery device, the fluid into the space between the first and second layers of eye tissue;

wherein the administering of the fluid expands the space between the first and second layers of eye tissue as the first layer of eye tissue is thinned by deposition of the fluid in the space;

wherein the administering of the fluid is adapted to result in a reduced intraocular pressure in the eye.

18. A method, of guiding a glaucoma surgery, comprising:

advancing a distal portion of a treatment device, the treatment device having a hemoglobin detector, through an anterior chamber of an eye to a location adjacent Schlemm'"'"'s canal of the eye; and

detecting, with the hemoglobin detector, a presence of blood in Schlemm'"'"'s canal.

19. The method of claim 18, wherein the presence of blood is detected with optical spectroscopy.

20. The method of claim 18, further comprising:

identifying a location of Schlemm'"'"'s canal based on the presence of the blood in Schlemm'"'"'s canal; and

creating an aperture in the trabecular meshwork of the eye adjacent to the location of the blood.

21. A method, of performing glaucoma surgery, comprising:

advancing a distal portion of a treatment device through an anterior chamber of an eye to a location adjacent Schlemm'"'"'s canal of the eye;

penetrating an inner wall of Schlemm'"'"'s canal with a distal end of the treatment device; and

detecting penetration of the inner wall of Schlemm'"'"'s canal with at least one of chemical detection, photochemical detection, hemoglobin detection, optical spectroscopy, detection of a fluorescent substance, and photoacoustic spectroscopy.

22. An apparatus, for treating glaucoma of an eye, comprising:

a laser that is configured to produce a beam that ablates a region of a trabecular meshwork of the eye; and

a delivery system that is configured to direct the beam from within the eye to the trabecular meshwork of the eye, said delivery system being further configured to direct a gas bubble in the eye through the trabecular meshwork and into Schlemm'"'"'s canal of the eye.

23. The apparatus of claim 22, further comprising a sensor coupled to the delivery system, the sensor being configured to detect contact of a portion of the apparatus with a surface of the trabecular meshwork.

24. The apparatus of claim 22, wherein the delivery system comprises a hood that is configured to direct the gas bubble through the trabecular meshwork.

25. The apparatus of claim 22, further comprising a gas injector module, said gas injector module configured to inject a gas from outside the eye into an aperture formed in the trabecular meshwork and into Schlemm'"'"'s canal.

26. The apparatus of claim 22, further comprising a sensor module that is configured to detect patency of an aperture formed in the trabecular meshwork.

27. The apparatus of claim 26, wherein the sensor module is configured to detect a gas bubble that moves from Schlemm'"'"'s canal through the aperture.

28. An apparatus, for treating glaucoma of an eye, comprising:

a laser device that is configured to deliver laser light that ablates trabecular meshwork tissue of an eye to create an aperture in the trabecular meshwork; and

a contact sensor that detects contact of the apparatus with the trabecular meshwork;

wherein the laser device directs cavitation bubbles through the aperture in the trabecular meshwork into Schlemm'"'"'s canal.

29. A method, for treating glaucoma of an eye, comprising:

creating an aperture in eye tissue;

forming a gas bubble within the eye by ablation of eye tissue; and

directing the gas bubble from within the anterior chamber through the aperture and into a natural aqueous outflow pathway of the eye, thereby modifying the natural aqueous outflow pathway.

30. The method of claim 29, wherein the natural aqueous outflow pathway comprises at least one of Schlemm'"'"'s canal, collector channels, and an episcleral vein of the eye.

31. A method, for treating glaucoma of an eye, comprising:

photoablating a tissue of an eye at a first treatment site, resulting in the formation of a first aperture in the eye tissue;

photoablating the eye tissue at a second treatment site, resulting in the formation of a second aperture in the eye tissue; and

forming a gas bubble within the eye by ablation of eye tissue;

directing the gas bubble from within the anterior chamber of the eye through the first aperture and into a natural aqueous outflow pathway of the eye; and

detecting the presence of the gas bubble after the gas bubble moves through the natural aqueous outflow pathway through the second aperture and into the anterior chamber.

32. The method of claim 31, wherein the eye tissue comprises a trabecular meshwork of the eye, and the natural aqueous outflow pathway comprises Schlemm'"'"'s canal of the eye.

33. A method, of treating glaucoma, comprising:

providing a volume of gas that comprises a therapeutic agent; and

directing the volume of gas into an eye to alter, move, or separate structures within the eye.