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) advancing a conduit of a viscoelastic fluid delivery device comprising a handle with a fluid reservoir contained therein to Schlemm's canal via the anterior chamber using the handle, wherein the conduit is at the distal end of the handle;
b) using the handle to cause the conduit to advance into Schlemm's canal; and
c) delivering a volume of the viscoelastic fluid from the fluid reservoir through the conduit by decreasing the volume of the fluid reservoir,
wherein a total volume of delivered viscoelastic fluid is sufficient to disrupt the structure of Schlemm's canal and surrounding tissues to reduce intraocular pressure, and
wherein the method further comprises loading the viscoelastic fluid into the fluid reservoir via an opening in the handle of the viscoelastic fluid delivery device.
2. The method of claim 1 , wherein the total volume is sufficient to increase the porosity of the trabecular meshwork or stretch the trabecular meshwork using the viscoelastic fluid.
3. The method of claim 1 , wherein the total volume is sufficient to form microtears in the trabecular meshwork using the viscoelastic fluid.
4. The method of claim 1 , wherein the total volume of viscoelastic fluid is delivered from a single access point in Schlemm's canal.
5. The method of claim 1 , wherein the viscoelastic fluid delivery device is a single-handed, single-operator controlled device.
6. The method of claim 1 , wherein delivering the volume of viscoelastic fluid comprises advancing a slide on the handle of the viscoelastic fluid delivery device.
7. The method of claim 1 , wherein the viscoelastic fluid delivery device further comprises a cannula coupled to the handle and wherein the conduit is slidably positioned within the cannula.
8. The method of claim 7 , wherein a distal end of the cannula is configured to pierce trabecular meshwork.
9. The method of claim 7 , wherein the handle further comprises a slide configured to advance the conduit around Schlemm's canal.
10. The method of claim 1 , wherein the conduit is configured to be advanced at least 90 degrees around Schlemm's canal.
11. The method of claim 1 , wherein an outer diameter of the conduit is between about 180 microns and about 300 microns.
12. The method of claim 1 , wherein the handle has a length between about 4 inches and 10 inches.
13. The method of claim 7 , wherein the cannula is metallic.
14. A method for reducing intraocular pressure comprising:
a) advancing a conduit of a viscoelastic fluid delivery device comprising a handle with a fluid reservoir contained therein to Schlemm's canal via the anterior chamber using the handle, wherein the conduit is at the distal end of the handle;
b) using the handle to cause the conduit to advance into Schlemm's canal; and
c) delivering a volume of the viscoelastic fluid from the fluid reservoir through the conduit,
wherein a total volume of delivered viscoelastic fluid is sufficient to disrupt the structure of Schlemm's canal and surrounding tissues to reduce intraocular pressure, and
wherein the method further comprises loading the viscoelastic fluid into the fluid reservoir via an opening in the handle of the viscoelastic fluid delivery device.
15. The method of claim 14 , wherein the total volume is sufficient to perforate the trabecular meshwork using the viscoelastic fluid.
16. The method of claim 14 , wherein the total volume is sufficient to dilate Schlemm's canal using the viscoelastic fluid.
17. The method of claim 14 , wherein the total volume is sufficient to dilate collector channels using the viscoelastic fluid.
18. The method of claim 14 , wherein the method is implant-free.
19. The method of claim 14 , wherein the total volume is sufficient to increase the porosity of the trabecular meshwork or stretch the trabecular meshwork using the viscoelastic fluid.
20. The method of claim 14 , wherein the total volume is sufficient to form microtears in the trabecular meshwork using the viscoelastic fluid.
21. The method of claim 14 , wherein the viscoelastic fluid delivery device is a single-handed, single-operator controlled device.
22. The method of claim 14 , wherein delivering the volume of viscoelastic fluid comprises advancing a slide on the handle of the viscoelastic fluid delivery device.
23. The method of claim 14 , wherein the total volume of viscoelastic fluid is delivered from a single access point in Schlemm's canal.
24. The method of claim 14 , wherein the viscoelastic fluid delivery device further comprises a cannula coupled to the handle and wherein the conduit is slidably positioned within the cannula.
25. The method of claim 24 , wherein a distal end of the cannula is configured to pierce trabecular meshwork.
26. The method of claim 24 , wherein the handle further comprises a slide configured to advance the conduit around Schlemm's canal.
27. The method of claim 14 , wherein the conduit is configured to be advanced at least 90 degrees around Schlemm's canal.
28. The method of claim 14 , wherein an outer diameter of the conduit is between about 180 microns and about 300 microns.
29. The method of claim 14 , wherein the handle has a length between about 4 inches and 10 inches.
30. The method of claim 14 , wherein the conduit has an enlarged distal tip.