Minimally invasive glaucoma surgical instrument and method

• US 9,226,850 B2
• Filed: 03/25/2013
• Issued: 01/05/2016
• Est. Priority Date: 01/18/2001
• Status: Expired due to Term

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Baerveldt, George, Chuck, Roy
• Primary Examiner(s): FARAH, AHMED M
• Application Number:
  US13/850,231
• Publication Number:
  US 20130289545A1
• Time in Patent Office: 1,016 Days
• Field of Search: 606 4- 6, 606/10, 606/32, 606 41- 50, 606/167, 607/96, 607 98-105, 128/898
• US Class Current: 1/1
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 2017/320069 for ablating tissue
• CPC Class Codes: A61B 2017/32007 with suction or vacuum means
• CPC Class Codes: A61B 2017/320073 probe
• CPC Class Codes: A61B 2017/320075 single edge blade, e.g. for cutting
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 2034/254 being adapted depending on the stage of the surgical procedure
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61B 2218/003 using a spray or a foam
• CPC Class Codes: A61B 2218/007 Aspiration
• 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 9/00745 using mechanical vibrations, e.g. ultrasonic
• 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 9/0079 using non-laser electromagnetic radiation, e.g. non-coherent light or microwaves
• CPC Class Codes: A61F 9/008 using laser
• CPC Class Codes: A61F 9/00802 for photoablation
• CPC Class Codes: A61F 9/00825 for photodisruption

Abstract

Apparatuses and methods for the treatment of glaucoma are provided. The instrument uses either cauterization, a laser to ablate, sonic or ultrasonic energy to emulsify, or mechanical cutting of a portion of the trabecular meshwork. The instrument may also be provided with irrigation, aspiration, and a footplate. The footplate is used to enter Schlemm'"'"'s canal, serves as a guide, and also protects Schlemm'"'"'s canal.

Claims

1. A device for forming an opening in the trabecular meshwork of the eye of a subject, said device comprising:

an elongate probe having a distal end that is insertable into the anterior chamber of the eye;

a member extending from the distal end of the elongate probe, said member having opposing upper and lower sides; and

a cutting or ablating apparatus is located adjacent to the upper side of the member;

said member being insertable, while the elongate shaft extends through the anterior chamber of the eye, into the Schlemm'"'"'s canal such that the member is advanceable through a portion of Schlem'"'"'s canal with the cutting or ablating apparatus cutting or ablating trabecular meshwork tissue as the member is being so advanced.

2. A device according to claim 1 wherein the cutting or ablating apparatus forms an elongate opening or slit in the trabecular meshwork as the member is being advanced through a portion of Schlem'"'"'s canal.

3. A device according to claim 1 wherein the member has a tip that is configured to penetrate through the trabecular meshwork as it is being inserted into Schlemm'"'"'s canal.

4. A device according to claim 1 wherein the member extends at an angle relative to the elongate probe.

5. A device according to claim 4 wherein the member is substantially perpendicular to the elongate probe.

6. A device according to claim 1 further comprising an aspiration opening.

7. A device according to claim 1 further comprising an irrigation opening.

8. A device according to claim 1 further comprising an aspiration opening and an irrigation opening.

9. A device according to claim 1 further comprising a second member that extends from the elongate probe and is generally parallel to the member on whose upper surface the cutting or ablating apparatus is located.

10. A device according to claim 9 wherein the second member is juxtaposed to and spaced away from the upper surface the cutting or ablating apparatus is located.

11. A device according to claim 1 wherein the cutting or ablating apparatus comprises an electrode.

12. A device according to claim 1 wherein the cutting or ablating apparatus comprises a radiofrequency electrode.

13. A device according to claim 1 wherein the cutting or ablating apparatus comprises a cutting blade.

14. A device according to claim 1 wherein the cutting or ablating apparatus comprises a laser.

15. A device according to claim 1 wherein the cutting or ablating apparatus emits sonic energy.

16. A device according to claim 1 wherein the cutting or ablating apparatus emits acoustic energy.

17. A device according to claim 1 wherein the cutting or ablating apparatus emits ultrasonic energy.

18. A method for improving drainage of fluid from the anterior chamber of an eye of a subject, said method comprising the steps of:

A) preparing a glaucoma treatment device that comprises i) an elongate probe having a distal end that is insertable into the anterior chamber of the eye, ii) a member extending from the distal end of the elongate probe, said member having opposing upper and lower sides and iii) a cutting or ablating apparatus located adjacent to the upper side of the member;

B) inserting a distal portion of the elongate probe into the anterior chamber of the subject'"'"'s eye;

C) with the distal portion of the probe positioned in the anterior chamber of the eye, positioning the member in Schlemm'"'"'s canal with the cutting or ablating apparatus positioned to cut or ablate tissue of the trabecular meshwork; and

D) advancing the member through a segment of Schlem'"'"'s canal such that the cutting or ablating apparatus cuts or ablates a segment of the trabecular meshwork thereby forming an opening through which fluid may drain from the anterior chamber into Schlemm'"'"'s canal.

19. A method according to claim 18 wherein the device provided in Step A further comprises an aspiration opening through which matter may be aspirated and wherein the method further comprises the step of aspirating matter from the eye through said aspiration opening.

20. A method according to claim 19 wherein the matter aspirated through said aspiration opening comprises tissue that has been severed from the trabecular meshwork during performance of Step D.

21. A method according to claim 18 wherein the device further comprises an irrigation opening through which fluid may be infused and wherein the method further comprises the step of infusing a fluid into the eye through said irrigation opening.

22. A method according to claim 18 wherein the device further comprises an irrigation opening through which fluid may be infused and an aspiration opening through which fluid may be aspirated, and wherein the method further comprises the step of infusing a fluid into the eye through said irrigation opening and the step of aspirating matter from the eye through said aspiration opening.

23. A method according to claim 18 wherein the device is moved such that the member advances through a segment of Schlem'"'"'s canal during performance of Step D causing the cutting or ablating apparatus to form an elongate opening or slit in the trabecular meshwork.

24. A method according to claim 18 wherein the distal portion of the probe is inserted into the anterior chamber of the subject'"'"'s eye through a corneal incision.

25. A method according to claim 18 further comprising the steps of:

(E) removing the device; and

(F) sealing the corneal incision.

26. A method according to claim 25 wherein the corneal incision is sealed by injecting a balanced salt solution into the corneal stroma.

27. A method according to claim 25 wherein the corneal incision is sealed by placement of a suture.

28. A method according to claim 18 wherein the device further comprises a second member that extends from the elongate probe parallel to the upper side of the member on which the cutting or ablating apparatus is located and in Step C the second member is positioned within the anterior chamber adjacent to the trabecular meshwork.