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 cartridge for use with a system for preparation of an implant and ab interno insertion of the implant into an eye, the cartridge comprising:
a base having an upper surface defining a recess sized and shaped to receive a patch of material to be cut into an implant;
a cover movably coupled to the base between an open configuration and a closed configuration, the cover having a lower surface arranged to appose the upper surface of the base when the cover is in the closed configuration; and
a cutting member comprising a pair of blades configured to extend below the lower surface of the cover to cut the patch of material into the implant.
2. The cartridge of claim 1 , wherein when the cover is in the closed configuration the patch of material is held fixed relative to the base.
3. The cartridge of claim 1 , wherein when the cover is in the closed configuration, the patch of material is compressed.
4. The cartridge of claim 1 , wherein the cover is configured to apply tension on the patch of material compressed.
5. A system for preparation of an implant and ab interno insertion of the implant into an eye, the system comprising:
a trephination cartridge configured to be moved between an open configuration and a closed configuration for loading a patch of a material in the cartridge, the cartridge comprising:
a base having an upper surface configured to receive the patch of material;
a cover having a lower surface configured to abut against the patch of material when the cartridge is in the closed configuration; and
a cutting member having a pair of blades and a spacer defining a gap between the blades, wherein the pair of blades is configured to extend below the lower surface of the cover to penetrate the patch of the material at two locations to form a strip of the material having a width narrower than a width of the patch of the material.
6. The system of claim 5 , wherein the cover and the base are hinged relative to one another.
7. The system of claim 5 , wherein the cover and the base reversibly coupled to one another.
8. The system of claim 5 , wherein the gap defined by the spacer determines the width of the strip.
9. The system of claim 5 , wherein the blades include single bevel edges.
10. The system of claim 5 , further comprising the patch of the material.
11. The system of claim 5 , wherein the material comprises biologically-derived material suitable for transplant into the eye.
12. The system of claim 11 , wherein the biologically-derived material comprises tissue harvested from a donor or from the eye.
13. The system of claim 11 , wherein the biologically-derived material is autograft, allograft, or xenograft material.
14. The system of claim 5 , wherein the material is engineered tissue.
15. The system of claim 14 , wherein the engineered tissue is 3D-printed material suitable for implantation.
16. The system of claim 5 , wherein the implant comprises one or more therapeutic agents.
17. The system of claim 5 , further comprising a delivery device comprising:
a proximal handle having one or more actuators;
an inner pusher; and
an outer tube comprising a lumen sized to receive the inner pusher.
18. The system of claim 17 , wherein the inner pusher is configured to be advanced moving a distal end of the inner pusher distally away from the handle using the one or more actuators.
19. The system of claim 17 , wherein the lumen of the outer tube is sized to receive the width of the strip.
20. The system of claim 17 , wherein the outer tube is configured to inject viscoelastic using the inner pusher as a plunger.
21. The system of claim 17 , wherein at least a proximal portion of the outer tube extends along a longitudinal axis and wherein a distal end region of the outer tube is angled away from the longitudinal axis.
22. The system of claim 17 , wherein a distal-most tip of the outer tube is blunt to allow for dissecting between tissues of the eye without cutting the tissues.
23. The system of claim 17 , wherein a distal end region of the outer tube has a maximum outer diameter that is no greater than about 1.3 mm.
24. The system of claim 17 , wherein the outer tube is a hypotube having an inner diameter that is less than about 0.036″ to about 0.009″.
25. The system of claim 17 , wherein the outer tube is coupled to a first actuator of the one or more actuators and the inner pusher is coupled to a second actuator.
26. The system of claim 17 , wherein distal advancement of the inner pusher urges the implant distally through the lumen of the outer tube into a primed position near a distal opening from the lumen of the outer tube.
27. The system of claim 26 , wherein proximal retraction of the outer tube while the inner pusher remains stationary relative to the handle unsheathes the implant to deploy it within the eye.