Method and apparatus for subretinal administration of therapeutic agent
An apparatus for delivering therapeutic agent to an eye comprises a body, a cannula, a hollow needle, and an actuation assembly. The cannula extends distally from the body and is sized and configured to be insertable between a choroid and a sclera of a patient's eye. The actuation assembly is operable to actuate the needle relative to the cannula to thereby drive a distal portion of the needle along an exit axis that is obliquely oriented relative to the longitudinal axis of the cannula. The cannula may be inserted through a sclerotomy incision to position a distal end of the cannula at a posterior region of the eye, between the choroid and sclera. The needle may be advanced through the choroid to deliver the therapeutic agent adjacent to the potential space between the neurosensory retina and the retinal pigment epithelium layer, adjacent to the area of geographic atrophy.
1. An apparatus for delivering therapeutic agent to an eye, wherein the apparatus comprises:
(a) a body;
(b) a flexible cannula extending distally from the body, wherein the flexible cannula is sized and configured to be insertable between a choroid and a sclera of an eye of a patient, wherein the flexible cannula defines a longitudinal axis, wherein the flexible cannula includes an atraumatic distal end;
(c) a needle, wherein the needle is slidable relative to the flexible cannula between a retracted position and an extended position; and
(d) an actuation assembly, wherein the actuation assembly is operable to actuate the needle relative to the flexible cannula to thereby drive a distal portion of the needle along an exit axis that is obliquely oriented relative to the longitudinal axis of the flexible cannula, wherein the exit axis is oriented at an angle between 5° and 30° relative to the longitudinal axis of the flexible cannula,
wherein the needle is configured to pierce through the choroid into a subretinal space of the eye when the needle is in the extended position with the flexible cannula inserted between the choroid and the sclera,
wherein the flexible cannula has a generally rectangular cross-sectional profile with rounded sides in a plane perpendicular to the longitudinal axis.
2. The apparatus of claim 1 , wherein the actuation assembly includes an actuation member that is movable relative to the body to actuate the needle.
3. The apparatus of claim 2 , wherein the actuation member is rotatable relative to the body to actuate the needle.
4. The apparatus of claim 3 , wherein the actuation assembly includes a threaded member that is associated with the actuation member, wherein the threaded member is configured to engage a threaded bore in the body to actuate the needle when the actuation member is rotated relative to the body.
5. The apparatus of claim 1 , wherein the needle includes a sharp distal tip.
6. The apparatus of claim 5 , wherein the sharp distal tip of the needle comprises a first bevel, a second bevel, and a third bevel, wherein the first bevel, second bevel, and third bevel are each oriented obliquely relative to each other.
7. The apparatus of claim 1 , wherein the exit axis is oriented at an angle between 7° and 9° relative to the longitudinal axis of the flexible cannula.
8. The apparatus of claim 1 , wherein the flexible cannula includes a blunt distal tip.
9. The apparatus of claim 1 , wherein the flexible cannula includes a beveled distal end, wherein the beveled distal end has a bevel angle, wherein the bevel angle is between 10° and 30°.
10. The apparatus of claim 1 , wherein the flexible cannula defines a plurality of lumens extending longitudinally through the length of the flexible cannula, wherein at least one lumen of the plurality of lumens is configured to slidably receive the needle.
11. The apparatus of claim 1 , further comprising a needle coupler configured to couple at least two separate fluid sources with the needle.
12. The apparatus of claim 1 , wherein the flexible cannula has a bending stiffness between 2.0×10 −6 Nm 2 to 6.0×10 −6 Nm 2 .
13. The apparatus of claim 1 , further comprising a valve assembly, wherein the valve assembly is operable to provide a fluid coupling between a fluid source and the needle, wherein the valve assembly is configured to translate with the needle relative to the body.
14. The apparatus of claim 1 , wherein a distal portion of the flexible cannula has a distal opening oriented transversely relative to the longitudinal axis of the flexible cannula, wherein the needle is configured to exit the flexible cannula via the distal opening.
15. The apparatus of claim 14 , wherein the flexible cannula has a closed distal end, wherein the distal opening is proximal to the closed distal end.
16. The apparatus of claim 14 , further comprising a needle guide disposed in the flexible cannula, wherein the needle is slidably disposed in the needle guide, wherein the needle guide is configured to guide the needle toward the distal opening.
17. The apparatus of claim 1 , wherein the flexible cannula defines a lumen extending distally from the body toward the atraumatic distal end, wherein the lumen is configured to slidably receive the needle, wherein at least a portion of the lumen terminates proximally relative to the atraumatic distal end.
18. The apparatus of claim 17 , wherein the portion of the lumen terminating proximally relative to the atraumatic distal end defines an opening, wherein the needle is configured to exit the flexible cannula via the opening.
19. An apparatus for delivering therapeutic agent to an eye, wherein the apparatus comprises:
(a) a body;
(b) a flexible cannula extending distally from the body, wherein the flexible cannula is sized and configured to be insertable between a choroid and a sclera of an eye of a patient, wherein the flexible cannula defines a longitudinal axis, wherein the flexible cannula has an opening, wherein the flexible cannula includes a rounded, atraumatic distal end, wherein the flexible cannula includes a pair of opposing rounded sides and a pair of opposing flat sides extending between the pair of opposing rounded sides, wherein the pair of opposing flat sides and the pair of opposing rounded sides collectively define an outer periphery of the flexible cannula;
(c) a needle, wherein the needle is slidable relative to the flexible cannula between a retracted position and an extended position; and
(d) an actuation assembly, wherein the actuation assembly is operable to actuate the needle relative to the flexible cannula to thereby drive a distal portion of the needle out through the opening of the flexible cannula and along an exit axis that is obliquely oriented relative to the longitudinal axis of the flexible cannula,
wherein the needle is configured to pierce through the choroid into a subretinal space of the eye when the needle is in the extended position with the flexible cannula inserted between the choroid and the sclera.
20. An apparatus for delivering therapeutic agent to an eye, wherein the apparatus comprises:
(a) a body;
(b) a flexible cannula extending distally from the body, wherein the flexible cannula is sized and configured to be insertable between a choroid and a sclera of an eye of a patient, wherein the flexible cannula defines a longitudinal axis, wherein the flexible cannula comprises:
(i) a pair of opposing rounded sides,
(ii) a pair of opposing flat sides adjacent to the rounded sides, wherein the pair of opposing flat sides and the pair of opposing rounded sides collectively define an outer periphery of the flexible cannula,
(iii) an atraumatic distal end, and
(iv) an opening at or near the distal end;
(c) a needle, wherein the needle is slidable relative to the flexible cannula between a retracted position and an extended position; and
(d) an actuation assembly, wherein the actuation assembly is operable to actuate the needle relative to the flexible cannula to thereby drive a distal portion of the needle out through the opening of the flexible cannula and along an exit axis that is obliquely oriented relative to the longitudinal axis of the flexible cannula,
wherein the needle is configured to pierce through the choroid into a subretinal space of the eye when the needle is in the extended position with the flexible cannula inserted between the choroid and the sclera.