Method for treating glaucoma

• US 9,820,883 B2
• Filed: 05/21/2001
• Issued: 11/21/2017
• Est. Priority Date: 05/19/2000
• Status: Expired due to Term

• Current Assignee: Michael S. Berlin
• Original Assignee: Michael S. Berlin
• Inventors: Berlin, Michael S.
• Primary Examiner(s): Shay, David
• Application Number:
  US98/608,42
• Time in Patent Office: 6,028 Days
• Field of Search: 606 3- 6, 606 10- 16, 606 17, 606 18, 604 9, 604 22, 604 65, 604 48, 600 47, 600439, 600476
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 2017/00017 Electrical control of surgical instruments
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00066 intensity
• CPC Class Codes: A61B 2017/00092 using thermocouples
• CPC Class Codes: A61B 2017/00119 alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00321 Head or parts thereof
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00648 using more than one sensed parameter
• CPC Class Codes: A61B 2018/00904 Automatic detection of target tissue
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/2255 Optical elements at the distal end of probe tips
• CPC Class Codes: A61F 2/14 Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
• CPC Class Codes: A61F 2/15 Implant having one or more holes, e.g. for nutrient transport, for facilitating handling
• 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 9/00 : Methods 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 caps with means for protecting the eyes A42B1/018; visors for helmets A42B3/22; retractors A61B17/02; manipulators specially adapted for use in surgery A61B34/70; appliances to aid invalids to move about A61H3/00; exercisers for the eyes A61H5/00; eye baths A61H35/02; sunglasses or goggles having the same features as spectacles G02C
• 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 9/008 : using laser
• CPC Class Codes: A61F 9/00802 : for photoablation

Abstract

A method and delivery system 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. Pulsed laser radiation is delivered from the distal end of a fiber-optic probe sufficient to cause photoablation of selected portions of the trabecular meshwork, the juxtacanalicular trabecular meshwork and an inner wall of Schlemm'"'"'s canal in the target site. The fiber-optic probe may be advanced so as to create an aperture in the inner wall of Schlemm'"'"'s canal in which fluid from the anterior chamber of the eye flows. The method and delivery system may further be used on any tissue types in the body.

Claims

1. A method for reducing intraocular pressure in a living human eye of a patient, said living human eye comprising a sclera, an anterior chamber, a trabecular meshwork, a Schlemm'"'"'s canal having an inner wall, an outer wall, and a lumen, the method comprising:

inserting a probe into said anterior chamber of said eye, said probe comprising an optical fiber stiffened with an encapsulating sheath, said optical fiber and said encapsulating sheath extending to a beveled distal end of said optical fiber;

locating a target site comprising a portion of the trabecular meshwork adjacent the Schlemm'"'"'s canal;

positioning said beveled distal end of said probe to contact said portion of said trabecular meshwork at said target site;

compressing said portion of said trabecular meshwork at said target site to a reduced thickness with said beveled distal end whereby said distal end is oriented to uniformly compress said portion of said trabecular meshwork; and

delivering from said probe to said selected target site a plurality of pulses of ultraviolet laser energy to form an aperture between said anterior chamber and said Schlemm'"'"'s canal at said target site and said aperture does not perforate the sclera, thereby permitting fluid to flow between said anterior chamber and said Schlemm'"'"'s canal so as to reduce the intraocular pressure in said living human eye with insignificant healing in response to said aperture.

2. The method of claim 1, wherein said Schlemm'"'"'s canal is located using ultrasound.

3. The method of claim 1, wherein said Schlemm'"'"'s canal is located using optical coherence tomography.

4. The method of claim 1, wherein said step of inserting said probe into said anterior chamber of said eye occurs after said step of locating said target site.

5. The method of claim 1, further comprising generating the plurality of pulses of the ultraviolet laser energy with a xenon chloride excimer laser.

6. The method of claim 1, further comprising visually monitoring said trabecular meshwork while compressing said portion of said trabecular meshwork.

7. The method of claim 1, further comprising detecting a location of said probe relative to said portion of said trabecular meshwork and said portion of said inner wall of said Schlemm'"'"'s canal.

8. The method of claim 1, wherein said plurality of pulses is delivered at a repetition rate within a range from 5 Hertz to 75 Hertz.

9. The method of claim 1, wherein said ultraviolet laser energy comprises a wavelength of 308 nm.

10. The method of claim 1, wherein said plurality of pulses is delivered through a plurality of optical fibers.

11. The method of claim 1, wherein said step of inserting a probe into said anterior chamber of said eye occurs prior to said step of locating said target site.

12. The method of claim 11, wherein said probe is utilized to locate said trabecular meshwork.

13. The method of claim 1, wherein said portion of trabecular meshwork is uniformly compressed to a reduced thickness of no more than 90 um.

14. The method of claim 13, wherein the plurality of pulses of ultraviolet laser energy is delivered from said probe to said selected target site to penetrate the uniformly compressed portion of trabecular meshwork having the reduced thickness of no more than 90 um, so as to form the aperture into to Schlemm'"'"'s canal.