Ocular delivery systems and methods
Described here are systems and methods for accessing Schlemm's canal and for delivering an ocular device or fluid composition therein. The ocular devices may maintain the patency of Schlemm's canal without substantially interfering with transmural fluid flow across the canal. The fluid composition may be a viscoelastic fluid that is delivered into the canal to facilitate drainage of aqueous humor by disrupting the canal and surrounding trabeculocanalicular tissues. Tools for disrupting these tissues and minimally invasive methods for treating medical conditions associated with elevated intraocular pressure, including glaucoma, are also described.
1. An implant-free method for treating an eye condition using a device comprising a cannula and a flexible slidable conduit disposed within and extendable from the cannula, comprising:
advancing the cannula through the anterior chamber of the eye and into Schlemm's canal;
extending a distal portion of the flexible slidable conduit distally beyond a distal tip of the cannula to advance the flexible slidable conduit along a first arc of Schlemm's canal; and
withdrawing the cannula from Schlemm's canal and the anterior chamber without retracting the flexible slidable conduit, thereby tearing the trabecular meshwork.
2. The implant-free method of claim 1 , wherein the flexible slidable conduit comprises a lumen.
3. The implant-free method of claim 1 , wherein the flexible slidable conduit does not comprise a lumen.
4. The implant-free method of claim 1 , wherein the flexible slidable conduit is advanced along about a 90 degree arc of Schlemm's canal.
5. The implant-free method of claim 1 , wherein the flexible slidable conduit is advanced along about a 180 degree arc of Schlemm's canal.
6. The implant-free method of claim 1 , wherein the extended portion of the flexible slidable conduit has a length of about 20 mm.
7. The implant-free method of claim 1 , further comprising advancing the flexible slidable conduit along a second arc of Schlemm's canal.
8. The implant-free method of claim 7 , wherein the flexible slidable conduit is advanced along the first arc and along the second arc from a single access point in Schlemm's canal.
9. The implant-free method of claim 8 , wherein the first arc is about 180 degrees and the second arc is about 180 degrees.
10. The implant-free method of claim 1 , wherein the flexible slidable conduit has an outer diameter of between about 50 microns and about 500 microns.
11. The implant-free method of claim 1 , further comprising delivering viscoelastic fluid to Schlemm's canal through the flexible slidable conduit.
12. The implant-free method of claim 11 , wherein the viscoelastic fluid is delivered to about 90 degrees of Schlemm's canal.
13. The implant-free method of claim 11 , wherein the viscoelastic fluid is delivered to about 180 degrees of Schlemm's canal.
14. The implant-free method of claim 11 , wherein the viscoelastic fluid is delivered to about 360 degrees of Schlemm's canal.
15. The implant-free method of claim 14 , wherein about 10 μl of viscoelastic fluid is delivered.
16. The implant-free method of claim 14 , wherein about 20 μl of viscoelastic fluid is delivered.
17. The implant-free method of claim 1 , wherein about a 90 degree arc of the trabecular meshwork is torn.
18. The implant-free method of claim 1 , wherein about a 180 degree arc of the trabecular meshwork is torn.
19. An implant-free method for treating an eye condition using a device comprising a cannula and a flexible slidable conduit disposed within and extendable from the cannula, comprising:
advancing the cannula through the anterior chamber of the eye and into Schlemm's canal;
extending a distal portion of the flexible slidable conduit distally beyond a distal tip of the cannula to advance the flexible slidable conduit along a first arc of Schlemm's canal; and
withdrawing the cannula from Schlemm's canal and the anterior chamber without retracting the flexible slidable conduit, thereby disrupting the trabecular meshwork.
20. The implant-free method of claim 19 , wherein disrupting the trabecular meshwork reduces intraocular pressure.
21. The implant-free method of claim 19 , wherein disrupting the trabecular meshwork improves drainage of aqueous humor.
22. The implant-free method of claim 19 , wherein the flexible slidable conduit does not comprise a lumen.
23. The implant-free method of claim 19 , wherein the flexible slidable conduit is advanced along about a 180 degree arc of Schlemm's canal.
24. The implant-free method of claim 19 , further comprising advancing the flexible slidable conduit along a second arc of Schlemm's canal.
25. The implant-free method of claim 24 , wherein the flexible slidable conduit is advanced along the first arc and along the second arc from a single access point in Schlemm's canal.