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. A method for reducing intraocular pressure comprising:
entering Schlemm's canal using a flexible conduit, wherein the flexible conduit accesses Schlemm's canal via an ab interno approach;
advancing the flexible conduit around about 360 degrees of Schlemm's canal; and
delivering viscoelastic fluid around Schlemm's canal through the flexible conduit while withdrawing the flexible conduit,
wherein the total volume of delivered viscoelastic fluid is about 8 to 50 μl, and wherein the method is implant-free.
2. The method of claim 1 , wherein the viscoelastic fluid comprises sodium hyaluronate.
3. The method of claim 1 , wherein the conduit comprises an indicator that assists in identifying a location of the conduit.
4. The method of claim 1 , wherein the conduit comprises an atraumatic distal tip.
5. The method of claim 4 , wherein the conduit comprises an enlarged atraumatic distal tip.
6. The method of claim 4 , wherein the conduit comprises a polymer and a metal.
7. The method of claim 1 , wherein entering Schlemm's canal comprises entering through the trabecular meshwork.
8. The method of claim 1 , wherein the total volume of viscoelastic fluid is delivered during a single withdrawal of the conduit after advancing the flexible conduit from a single access point.
9. The method of claim 1 , wherein the volume of delivered viscoelastic fluid is about 9 μl.
10. The method of claim 1 , wherein the volume of delivered viscoelastic fluid is about 20 μl.
11. The method of claim 1 , wherein delivering viscoelastic fluid comprises pressurizing a viscoelastic fluid reservoir fluidly coupled to the flexible conduit.
12. A method for reducing intraocular pressure comprising:
entering Schlemm's canal using a flexible conduit, wherein the flexible conduit accesses Schlemm's canal via an ab interno approach;
advancing the flexible conduit around about 360 degrees of Schlemm's canal; and
delivering viscoelastic fluid around Schlemm's canal through the flexible conduit while withdrawing the flexible conduit,
wherein the total volume of delivered viscoelastic fluid is at least about 50 μl, and wherein the method is implant-free.
13. The method of claim 12 , wherein the viscoelastic fluid comprises hyaluronic acid, chondroitin sulfate, cellulose, or salts, derivatives, or mixtures thereof.
14. The method of claim 13 , wherein the viscoelastic fluid comprises sodium hyaluronate.
15. The method of claim 12 , wherein the conduit comprises an indicator that assists in identifying a location of the conduit.
16. The method of claim 12 , wherein the conduit comprises an atraumatic distal tip.
17. The method of claim 16 , wherein the conduit comprises an enlarged atraumatic distal tip.
18. The method of claim 16 , wherein the conduit comprises a polymer and a metal.
19. The method of claim 12 , wherein entering Schlemm's canal comprises entering through the trabecular meshwork.
20. The method of claim 12 , wherein the total volume of viscoelastic fluid is delivered during a single withdrawal of the conduit after advancing the flexible conduit from a single access point.
21. The method of claim 12 , wherein delivering viscoelastic fluid comprises pressurizing a viscoelastic fluid reservoir fluidly coupled to the flexible conduit.
22. A method for reducing intraocular pressure comprising:
entering Schlemm's canal using a flexible conduit, wherein the flexible conduit accesses Schlemm's canal via an ab interno approach;
advancing the flexible conduit around at least 180 degrees of Schlemm's canal; and
delivering viscoelastic fluid around Schlemm's canal through the flexible conduit while withdrawing the flexible conduit,
wherein the delivery of the viscoelastic fluid creates microtears in the trabecular meshwork, and wherein the method is implant-free.
23. The method of claim 22 , wherein advancing the flexible conduit around at least 180 degrees of Schlemm's canal comprises advancing the flexible conduit around about 360 degrees of Schlemm's canal.
24. The method of claim 22 , wherein the conduit comprises an indicator that assists in identifying a location of the conduit.
25. The method of claim 22 , wherein the conduit comprises an atraumatic distal tip.
26. The method of claim 25 , wherein the conduit comprises an enlarged atraumatic distal tip.
27. The method of claim 25 , wherein the conduit comprises a polymer and a metal.
28. The method of claim 22 , wherein entering Schlemm's canal comprises entering through the trabecular meshwork.
29. The method of claim 22 , wherein the total volume of viscoelastic fluid is delivered during a single withdrawal of the conduit after advancing the flexible conduit from a single access point.
30. A method for reducing intraocular pressure comprising:
entering Schlemm's canal using a flexible conduit comprising a polymer reinforced with a wire, wherein the flexible conduit comprises an enlarged atraumatic distal tip, and wherein the flexible conduit accesses Schlemm's canal via an ab interno approach;
advancing the flexible conduit around about 360 degrees of Schlemm's canal from a single access point; and
delivering viscoelastic fluid around about 360 degrees of Schlemm's canal through the flexible conduit while withdrawing the flexible conduit,
wherein the total volume of delivered viscoelastic fluid is at least about 50 μl, and wherein the method is implant-free.