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:
a) entering Schlemm's canal via the anterior chamber using a conduit coupled to a distal end of a handle having a fluid reservoir located entirely therein, wherein the handle is configured to deliver a viscoelastic fluid to the conduit, and wherein the conduit comprises a constant outer diameter until a distal end of the conduit and the conduit is sized to access a lumen of Schlemm's canal;
b) advancing the conduit along an arc of Schlemm's canal; and
c) delivering a volume of the viscoelastic fluid from the fluid reservoir through the conduit by decreasing a volume of the fluid reservoir,
wherein the volume of delivered viscoelastic fluid is sufficient to disrupt the structure of Schlemm's canal and surrounding tissues to reduce intraocular pressure.
2. The method of claim 1 , wherein the viscoelastic fluid is delivered about at least a 270 degree arc of Schlemm's canal.
3. The method of claim 1 , wherein the viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
4. The method of claim 1 , wherein the volume is sufficient to increase the porosity of the trabecular meshwork or stretch the trabecular meshwork using the viscoelastic fluid.
5. The method of claim 1 , wherein the volume is sufficient to form microtears in the trabecular meshwork using the viscoelastic fluid.
6. The method of claim 1 , wherein the volume is sufficient to perforate the trabecular meshwork using the viscoelastic fluid.
7. The method of claim 1 , wherein the volume is sufficient to dilate Schlemm's canal using the viscoelastic fluid.
8. The method of claim 1 , wherein the volume is sufficient to dilate collector channels using the viscoelastic fluid.
9. The method of claim 1 , wherein the volume of viscoelastic fluid is continuously delivered through the conduit to disrupt the structure of Schlemm's canal and surrounding tissues.
10. The method of claim 1 , wherein the handle comprises a wheeled drive assembly comprising a single rotatable component.
11. A method for reducing intraocular pressure comprising:
a) entering Schlemm's canal via the anterior chamber using a conduit of a viscoelastic fluid delivery device comprising a handle with a fluid reservoir located entirely therein, wherein the conduit is at a distal end of the handle and is in fluid communication with the fluid reservoir, and wherein the conduit has a constant outer diameter until a distal end of the conduit;
b) advancing the conduit along an arc of Schlemm's canal; and
c) delivering a volume of a viscoelastic fluid from the fluid reservoir through the conduit by decreasing a volume of the fluid reservoir,
wherein the volume of delivered viscoelastic fluid is sufficient to disrupt the structure of Schlemm's canal and surrounding tissues to reduce intraocular pressure.
12. The method of claim 11 , wherein the viscoelastic fluid is delivered about at least a 270 degree arc of Schlemm's canal.
13. The method of claim 11 , wherein the viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
14. The method of claim 11 , wherein the volume is sufficient to increase the porosity of the trabecular meshwork or stretch the trabecular meshwork using the viscoelastic fluid.
15. The method of claim 11 , wherein the volume is sufficient to form microtears in the trabecular meshwork using the viscoelastic fluid.
16. The method of claim 11 , wherein the volume is sufficient to perforate the trabecular meshwork using the viscoelastic fluid.
17. The method of claim 11 , wherein the volume is sufficient to dilate Schlemm's canal using the viscoelastic fluid.
18. The method of claim 11 , wherein the volume is sufficient to dilate collector channels using the viscoelastic fluid.
19. The method of claim 11 , wherein the volume of viscoelastic fluid is continuously delivered through the conduit to disrupt the structure of Schlemm's canal and surrounding tissues.
20. The method of claim 11 , wherein the handle comprises a wheeled drive assembly comprising a single rotatable component.
21. The method of claim 1 , wherein the viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
22. The method of claim 11 , wherein the viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.