Implantable biologic stent and system for biologic material shaping, preparation, and intraocular stenting for increased aqueous outflow and lowering of intraocular pressure
A system for preparation of an implant and ab interno insertion of the implant into an eye including a handle having one or more actuators and an elongated shaft having an outer sheath and an elongate member positioned within a lumen of the tubular outer sheath. The system includes a recess sized for holding a patch of material fixed relative to the handle and a cutting member movable relative to the handle and to the recess. The cutting member cuts the patch of material into an implant as the cutting member moves towards a cutting configuration. The implant, once cut, is axially aligned with the lumen of the tubular outer sheath. The inner elongate member is movable relative to the tubular outer sheath to advance the implant into a deployment position in the lumen of the tubular outer sheath for delivery into the eye. Related devices and methods are provided.
1. A method of preparing an implant for implantation into, and of inserting the implant into, an eye of a patient, the method comprising:
inserting a patch of a material into a proximal portion of an instrument, the instrument further comprising a cutting member and a distal portion sized for insertion into an eye;
cutting the patch with the cutting member to form the implant;
advancing the implant from the proximal portion of the instrument into a deployment position in a lumen of an elongate tubular member of the distal portion;
inserting the distal portion of the instrument into the anterior chamber of the eye;
positioning the distal portion adjacent eye tissue; and
deploying the implant from the instrument.
2. The method of claim 1 , wherein the inserting the patch of the material comprises inserting the patch into a recess in the proximal portion and closing a cover over the recess.
3. The method of claim 2 , wherein the cover is adapted to engage at least some portion of the patch of the material before the cutting.
4. The method of claim 2 , wherein at least a portion of the cover is transparent.
5. The method of claim 2 , wherein the cover prevents movement of the patch during the cutting of the patch with the cutting member.
6. The method of claim 1 , further comprising tensioning at least a portion of the patch of the material before cutting the patch.
7. The method of claim 6 , wherein the tensioning the portion of the patch comprises compressing a first portion and a second portion of the patch and tensioning a central portion of the patch, the central portion located between the first and second portions.
8. The method of claim 7 , wherein the central portion of the patch comprises the implant upon the cutting the patch with the cutting member.
9. The method of claim 6 , wherein the tensioning the portion of the patch comprises activating an actuator to tension the portion of the patch.
10. The method of claim 9 , wherein the activating an actuator comprises rotating the actuator to tension the portion of the patch.
11. The method of claim 3 , wherein the cover comprises an actuator, and wherein actuation of the actuator tensions at least a portion of the patch.
12. The method of claim 1 , further comprising inserting the distal portion of the instrument ab interno into the anterior chamber through a corneal incision, while the proximal portion of the instrument remains outside the eye.
13. The method of claim 1 , wherein the material comprises biologically-derived material suitable for implantation into the eye.
14. The method of claim 13 , wherein the biologically-derived material comprises tissue harvested from a donor or from the patient, or autograft, allograft, or xenograft material.
15. The method of claim 1 , wherein the material comprises an engineered or 3D-printed material suitable for implantation.
16. The method of claim 1 , wherein the implant comprises one or more therapeutic agents.
17. The method of claim 1 , wherein the deploying the implant from the instrument results in the implant residing at least in part between a ciliary body and sclera of the eye of the patient.
18. The method of claim 17 , wherein the implant resides between the ciliary body and sclera within a cyclodialysis cleft.
19. The method of claim 1 , wherein the cutting member comprises a cutting member lumen, a distal opening and a pair of opposed cutting edges, and wherein the cutting comprises advancing the cutting member to cut the patch of the material and capturing the implant within the cutting member lumen.
20. The method of claim 19 , wherein the pair of opposed cutting edges cut the patch in two locations to separate the implant from a remainder of the patch.
21. The method of claim 19 , wherein an internal diameter of the elongate tubular member is substantially the same as an internal diameter of the cutting member lumen.
22. The method of claim 19 , wherein a distal portion of the cutting member is beveled.
23. The method of claim 1 , wherein the implant comprises a longitudinal axis and wherein the longitudinal axis of the implant remains aligned with a longitudinal axis of the lumen of the elongate tubular member as the cutting member finishes cutting the patch to form the implant.
24. The method of claim 19 , wherein the advancing the implant from the proximal portion of the instrument comprises pushing the implant out of the cutting member lumen and into the lumen of the elongate tubular member of the distal portion.
25. The method of claim 1 , wherein a distal end region of the elongate tubular member is at least one of angled or curved or flexible.
26. The method of claim 1 , wherein the method further comprises:
activating a first actuator to tension at least a portion of the patch before the cutting;
activating a second actuator to advance the cutting member to cut the patch after the tensioning;
activating a third actuator to advance the implant into the deployment position; and
activating a fourth actuator to deploy the implant from the instrument, wherein each of the actuators is operatively coupled to the instrument.
27. The method of claim 1 , wherein the positioning the distal portion adjacent eye tissue comprises positioning the implant between the ciliary body and sclera while the implant remains at least partially inside the lumen of the distal portion.
28. The method of claim 1 , wherein the deploying the implant from the instrument comprises retracting the elongate tubular portion from the implant while maintaining the implant's position relative to the adjacent eye tissue.
29. The method of claim 1 , wherein a distal-most tip of the elongate tubular member is blunt to allow for dissecting the eye tissue without cutting the eye tissue.
30. The method of claim 2 , wherein the closing the cover over the recess comprises engaging a portion of the cover with a first portion of the patch to compress the first portion of the patch and to tension a second portion of the patch.