Glaucoma surgery methods and systems
DCFirst Claim
1. A method of guiding a 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, the treatment device having an optical waveguide for receiving light at the distal portion of the treatment device; and
identifying the location of Schlemm'"'"'s canal by detecting the presence of blood in Schlemm'"'"'s canal using optical spectroscopy applied to light transmitted by the optical waveguide.
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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.
118 Citations
49 Claims
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1. A method of guiding a glaucoma surgery, comprising:
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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, the treatment device having an optical waveguide for receiving light at the distal portion of the treatment device; and identifying the location of Schlemm'"'"'s canal by detecting the presence of blood in Schlemm'"'"'s canal using optical spectroscopy applied to light transmitted by the optical waveguide. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37)
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38. A method, of performing glaucoma surgery, comprising:
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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, the treatment device having an optical waveguide for receiving light at the distal portion of the treatment device; 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 by detecting the presence of blood in Schlemm'"'"'s canal using optical spectroscopy applied to light transmitted by the optical waveguide. - View Dependent Claims (39, 40, 41, 42, 43)
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44. A method, of guiding glaucoma surgery, comprising:
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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, the treatment device having a physical-state-changing contact sensor disposed at a distal end thereof; and advancing the treatment device until the contact sensor senses contact of the distal end of the treatment device with the trabecular meshwork of the eye. - View Dependent Claims (45, 46, 47)
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48. A method of performing glaucoma surgery, comprising:
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photoablating tissue between the anterior chamber of the eye and Schlemm'"'"'s canal at a first treatment site, resulting in the formation of a first aperture in the eye tissue; photoablating the eye tissue between the anterior chamber of the eye and Schlemm'"'"'s canal at a second treatment site in the eye thereby forming gas bubbles; and detecting penetration of an inner wall of Schlemm'"'"'s canal by observing one or more gas bubbles moving from within Schlemm'"'"'s canal through a natural aqueous outflow pathway provided by the first aperture and into the anterior chamber.
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49. A method, of performing glaucoma surgery, comprising:
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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, the treatment device having an acoustic waveguide for receiving acoustic energy at the distal portion of the treatment device; 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 by photoacoustic spectroscopy applied to acoustic energy transmitted by the acoustic waveguide.
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Specification