CA2404037C - Apparatus and method for treating an ocular disorder - Google Patents
Apparatus and method for treating an ocular disorder Download PDFInfo
- Publication number
- CA2404037C CA2404037C CA2404037A CA2404037A CA2404037C CA 2404037 C CA2404037 C CA 2404037C CA 2404037 A CA2404037 A CA 2404037A CA 2404037 A CA2404037 A CA 2404037A CA 2404037 C CA2404037 C CA 2404037C
- Authority
- CA
- Canada
- Prior art keywords
- seton
- implant
- eye
- further characterized
- outlet
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—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
- A61F9/007—Methods or devices for eye surgery
- A61F9/00781—Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—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
- A61F9/0008—Introducing ophthalmic products into the ocular cavity or retaining products therein
- A61F9/0017—Introducing ophthalmic products into the ocular cavity or retaining products therein implantable in, or in contact with, the eye, e.g. ocular inserts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—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
- A61F9/007—Methods or devices for eye surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0048—Eye, e.g. artificial tears
- A61K9/0051—Ocular inserts, ocular implants
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
- A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P27/00—Drugs for disorders of the senses
- A61P27/02—Ophthalmic agents
- A61P27/06—Antiglaucoma agents or miotics
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—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
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00885—Methods or devices for eye surgery using laser for treating a particular disease
- A61F2009/00891—Glaucoma
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/06—Head
- A61M2210/0612—Eyes
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S623/00—Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
- Y10S623/902—Method of implanting
- Y10S623/905—Eye
Abstract
Surgical methods and related medical devices for treating glaucoma are disclosed. The method comprises trabecular bypass surgery, which involve bypassing diseased trabecular meshwork with the use of a seton implant. The seton implant is used to prevent a healing process known as filling in, which has a tendency to close surgically created openings in the trabecular meshwork. The surgical method and novel implant are addressed to the trabecular meshwork, which is a major site of resistance to outflow in glaucoma. In addition to bypassing the diseased trabecular meshwork at the level of the trabecular meshwork, existing outflow pathways are also used or restored. The seton implant is positioned through the trabecular meshwork so that an inlet end of the seton implant is exposed to the anterior chamber of the eye and an outlet end is positioned into fluid collection channels at about an exterior surface of the trabecular meshwork or up to the level of aqueous veins.
Claims (62)
PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A seton characterized by an inlet portion configured to extend through a portion of a trabecular meshwork of an eye; and an outlet portion having a maximum cross-sectional dimension no greater than about 500 µm such that the outlet portion is insertable into Schlemm's canal of said eye;
the seton further characterized in that the inlet portion is disposed at an angle relative to the outlet portion such that the seton is generally L-shaped.
the seton further characterized in that the inlet portion is disposed at an angle relative to the outlet portion such that the seton is generally L-shaped.
2. A seton characterized by an inlet portion configured to extend through a portion of a trabecular meshwork of an eye; and an outlet portion configured to extend into a physiologic outflow pathway of said eye;
the seton further characterized in that the inlet portion is disposed at an angle relative to the outlet portion such that the seton is generally L-shaped and that the angle between the inlet portion and the outlet portion is 70° to 110°.
the seton further characterized in that the inlet portion is disposed at an angle relative to the outlet portion such that the seton is generally L-shaped and that the angle between the inlet portion and the outlet portion is 70° to 110°.
3. The seton of claim 1 or 2, further characterized in that said outlet portion has a lumen with an oval cross-section having a long axis.
4. The seton of claim 3, further characterized in that the outlet portion has a longitudinal axis, said long axis and said longitudinal axis of said outlet portion defining a plane, said inlet portion having a longitudinal axis which lies outside said plane at an angle .theta.
thereto.
thereto.
5. The seton of claim 4, further characterized in that the angle .theta. is 70° to 110°.
6. The seton of any one of claims 1 to 5, further characterized in that the outlet portion has at least one protrusion configured to exert traction against an inner surface of Schlemm's canal.
7. The seton of claim 6, further characterized in that said protrusion includes at least one barb.
8. The seton of claim 6, further characterized in that said protrusion includes at least one ridge.
9. The seton of any one of claims 1 to 8, further characterized by a one-way valve in at least one of the inlet and outlet portions.
10. The seton of any one of claims 1 to 9, further characterized in that the seton is disposed in an elongate member.
11. The seton of claim 10, further characterized in that a cutting member is positioned at a distal end of said elongate member.
12. The seton of claim 11, further characterized in that said cutting member is selected from the group consisting of a knife, a laser probe, a pointed guide member, a sharpened distal end of said tube, and an ultrasonic cutter.
13. The seton of claim 10, further characterized in that said elongate member has an opening configured to allow fluid infusion into said eye.
14. The seton of claim 10, further characterized by a guide member within a lumen of said elongate member, configured to permit said seton to be advanced through said elongate member and to be positioned in the trabecular meshwork of said eye.
15. The seton of claim 14, further characterized in that the elongate member includes a lumen that conducts fluid toward a distal end of said elongate member.
16. The seton of any one of claims 1 to 15, further characterized in that the seton is rigid or semi-rigid.
17. The seton of any one of claims 1 to 16, further characterized in that the seton has only one inlet and only one outlet.
18. The seton of any one of claims 1 to 16, further characterized in that the seton has an elbow between the inlet portion and the outlet portion, and an outlet is at the elbow.
19. The seton of any one of claims 1 to 18, further characterized by a micropump disposed in the seton.
20. The seton of claim 6, further characterized in that said protrusion comprises a radial outward protrusion configured to retain the outlet portion in Schlemm's canal.
21. The seton of any one of claims 1 to 20, further characterized in that a lumen extends through the seton to permit fluid communication from an inlet section of the lumen, located within the inlet portion of the seton, to an outlet section of the lumen, located within the outlet portion of the seton.
22. The seton of any one of claims 1 to 21, further characterized in that the seton comprises a drug.
23. The seton of claim 22, further characterized in that at least a portion of the seton is coated with the drug.
24. The seton of any one of claims 1 to 23, further characterized in that at least one of the inlet and outlet portions is constructed of a non-biodegradable material.
25. The seton of claim 2, further characterized in that the physiologic outflow pathway is Schlemm's canal.
26. The seton of claim 2 or 25, further characterized in that the outlet portion has at least one protrusion configured to exert traction against a surface of the physiologic outflow pathway.
27. The seton of claim 26, further characterized in that said protrusion comprises a radial outward protrusion configured to retain the outlet portion in the physiologic outflow pathway.
28. Use of the seton of any one of claims 1 to 27 within any eye.
29. Use of the seton of any one of claims 1 to 27 for allowance of the flow of aqueous humor from an anterior chamber of an eye to Schlemm's canal of an eye.
30. Use of the seton of any one of claims 1 to 27 for placement within the trabecular meshwork of an eye.
31. Use of the seton of any one of claims 1 to 27 for bypassing diseased trabecular meshwork and restore existing outflow pathways.
32. Use of the seton of claim 2 to allow the flow of aqueous humor from an anterior chamber of an eye to a physiologic outflow pathway of an eye.
33. An implant for treating an ocular disorder, comprising:
an inlet portion configured to extend from an anterior chamber of an eye through a portion of a trabecular meshwork of the eye;
an outlet portion configured to be placed into Schlemm's canal of the eye; and a lumen extending through the implant, the lumen permitting fluid communication from an inlet section of the lumen, located within the inlet portion of the implant, to an outlet section of the lumen, located within the outlet portion of the outlet, wherein the inlet portion is disposed at an angle of 70° to 110°
relative to the outlet portion, and wherein the outlet portion has at least one radial outward protrusion configured to retain the outlet portion in Schlemm's canal.
an inlet portion configured to extend from an anterior chamber of an eye through a portion of a trabecular meshwork of the eye;
an outlet portion configured to be placed into Schlemm's canal of the eye; and a lumen extending through the implant, the lumen permitting fluid communication from an inlet section of the lumen, located within the inlet portion of the implant, to an outlet section of the lumen, located within the outlet portion of the outlet, wherein the inlet portion is disposed at an angle of 70° to 110°
relative to the outlet portion, and wherein the outlet portion has at least one radial outward protrusion configured to retain the outlet portion in Schlemm's canal.
34. The implant of claim 33, wherein the outlet section of the lumen has an oval cross section having a long axis.
35. The implant of claim 33 or 34, wherein the outlet portion has a longitudinal axis, wherein said long axis and said longitudinal axis of said outlet portion define a plane, and wherein said inlet portion has a longitudinal axis which lies outside said plane at an angle .theta. thereto.
36. The implant of Claim 35, wherein the angle .theta. is in the range from about 30°
to about 150°.
to about 150°.
37. The implant of any one of claims 33 to 36, wherein the at least one protrusion is further configured to exert traction against an inner surface of Schlemm's canal.
38. The implant of any one of claims 33 to 37, wherein the protrusion includes at least one barb.
39. The implant of any one of claims 33 to 38, wherein the protrusion includes at least one ridge.
40. The implant of any one of claims 33 to 39, wherein the implant further comprises a one-way valve in at least one of the inlet and outlet portions.
41. The implant of any one of claims 33 to 40, in combination with an elongate member in which the implant is disposed.
42. The implant of claim 41, wherein the combination further comprises a cutting member positioned at a distal end of the elongate member.
43. The implant of claim 42, wherein the cutting member of the combination is selected from the group consisting of a knife, a laser probe, a pointed guide member, a sharpened distal end of said tube, and an ultrasonic cutter.
44. The implant of any one of claims 41 to 43, wherein the elongate member of the combination has an opening configured to allow fluid infusion into the eye.
45. The implant of any one of claims 41 to 44, wherein the elongate member of the combination is a tube and further comprises an elongate guide member within a lumen of the elongate member configured to permit the implant to be advanced through the elongate member and to be positioned in the trabecular meshwork of the eye.
46. The implant of any one of claims 41 to 45, wherein the elongate member of the combination includes a lumen that conducts fluid toward a distal end of the elongate member.
47. The implant of any one of claims 33 to 46, wherein the implant is rigid or semi-rigid.
48. The implant of any one of claims 33 to 47, wherein the implant has only one inlet and only one outlet.
49. The implant of any one of claims 33 to 47, wherein the implant has an elbow between the inlet portion and the outlet portion, and wherein an additional outlet is in the proximal portion of the outlet portion.
50. The implant of any one of claims 33 to 49, wherein the implant allows aqueous flow in more than one direction.
51. The implant of any one of claims 33 to 50, wherein the implant further comprises a micropump.
52. The implant of any one of claims 33 to 51, wherein the implant has a plurality of lumens.
53. The implant of any one of claims 33 to 52, wherein the implant is coated with a drug.
54. Use of the implant of any one of claims 33 to 53 within any eye.
55. Use of the implant of any one of claims 33 to 53 within an eye.
56. Use of the implant of any one of claims 33 to 53 to allow for flow of aqueous humor from an anterior chamber of an eye to Schlemm's canal of an eye.
57. Use of the implant of any one of claims 33 to 53 to allow for fluid drainage from an anterior chamber of an eye to an existing, physiologic or physiological outflow pathway of the eye.
58. Use of the implant of any one of claims 33 to 53 to allow for fluid flow to an existing, physiologic or physiological outflow pathway of an eye.
59. Use of the implant of any one of claims 33 to 53 for placement of the implant within a trabecular meshwork of an eye.
60. Use of the implant of any one of claims 33 to 53 for placement of the implant in fluid communication with an existing, physiologic or physiological outflow pathway of an eye.
61. Use of the implant of any one of claims 33 to 53 for bypassing diseased trabecular meshwork and restore existing outflow pathways.
62. Use of the implant of any one of claims 33 to 53 to allow flow of aqueous humor from an anterior chamber of an eye to an existing, physiologic or physiological outflow pathway of an eye.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA2791154A CA2791154C (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/549,350 US6638239B1 (en) | 2000-04-14 | 2000-04-14 | Apparatus and method for treating glaucoma |
US09/549,350 | 2000-04-14 | ||
PCT/US2001/007398 WO2001078631A2 (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating glaucoma |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA2791154A Division CA2791154C (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2404037A1 CA2404037A1 (en) | 2001-10-25 |
CA2404037C true CA2404037C (en) | 2014-10-14 |
Family
ID=24192643
Family Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA2404037A Expired - Lifetime CA2404037C (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
CA2951478A Expired - Lifetime CA2951478A1 (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
CA2791154A Expired - Lifetime CA2791154C (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
Family Applications After (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA2951478A Expired - Lifetime CA2951478A1 (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
CA2791154A Expired - Lifetime CA2791154C (en) | 2000-04-14 | 2001-03-08 | Apparatus and method for treating an ocular disorder |
Country Status (9)
Country | Link |
---|---|
US (25) | US6638239B1 (en) |
EP (4) | EP2260803B1 (en) |
JP (4) | JP3985019B2 (en) |
AT (1) | ATE429882T1 (en) |
AU (4) | AU4552201A (en) |
CA (3) | CA2404037C (en) |
DE (1) | DE60138540D1 (en) |
ES (2) | ES2324700T3 (en) |
WO (1) | WO2001078631A2 (en) |
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