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 delivering fluid to Schlemm's canal comprising:
advancing a cannula to Schlemm's canal using an ab interno approach, wherein the cannula is connected to a handle of a single-handed, single-operator controlled device, and wherein the device comprises a fluid reservoir contained within the handle and a flexible conduit slidably positioned within the cannula; and
delivering a volume of viscoelastic fluid to an arc of Schlemm's canal through the flexible conduit, wherein the volume of viscoelastic fluid is at least about 8 μl, and wherein the method is implant-free.
2. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered about at least a 270 degree arc of Schlemm's canal.
3. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
4. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
5. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered during advancement of the flexible conduit.
6. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered during retraction of the flexible conduit.
7. The method of claim 1 , wherein the cannula comprises a curved distal portion.
8. The method of claim 1 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
9. The method of claim 1 , wherein the flexible conduit comprises an enlarged atraumatic distal tip.
10. The method of claim 1 , wherein the viscoelastic fluid comprises hyaluronic acid, chondroitin sulfate, cellulose, or salts, derivatives, or mixtures thereof.
11. A method for reducing intraocular pressure in an eye comprising:
advancing a cannula to Schlemm's canal using an ab interno approach, wherein the cannula is connected to a handle of a single-handed, single-operator controlled device, and wherein the device comprises a fluid reservoir contained within the handle and a flexible conduit slidably positioned within the cannula; and
delivering a volume of viscoelastic fluid to an arc of Schlemm's canal through the flexible conduit, wherein the delivery of the volume of viscoelastic fluid creates microtears in the trabecular meshwork, and wherein the method is implant-free.
12. The method of claim 11 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
13. The method of claim 11 , wherein the volume of viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
14. The method of claim 11 , wherein advancing the cannula to Schlemm's canal comprises advancing the cannula through the trabecular meshwork.
15. The method of claim 11 , wherein the volume of viscoelastic fluid is delivered during advancement of the flexible conduit.
16. The method of claim 11 , wherein the volume of viscoelastic fluid is delivered during retraction of the flexible conduit.
17. The method of claim 11 , wherein the cannula comprises a curved distal portion.
18. The method of claim 11 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
19. The method of claim 11 , wherein the flexible conduit comprises an enlarged atraumatic distal tip.
20. The method of claim 11 , wherein the viscoelastic fluid comprises hyaluronic acid, chondroitin sulfate, cellulose, or salts, derivatives, or mixtures thereof.
21. A method for delivering fluid to Schlemm's canal comprising:
advancing a cannula to Schlemm's canal using an ab interno approach, wherein the cannula is connected to a handle of a single-handed, single-operator controlled device, and wherein the device comprises a fluid reservoir contained within the handle and a flexible conduit slidably positioned within the cannula; and
delivering a volume of viscoelastic fluid to an arc of Schlemm's canal through the flexible conduit, wherein the volume of viscoelastic fluid is about 8 μl to 50 μl, and wherein the method is implant-free.
22. The method of claim 21 , wherein the volume of viscoelastic fluid is delivered about at least a 270 degree arc of Schlemm's canal.
23. The method of claim 21 , wherein the volume of viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
24. The method of claim 21 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
25. The method of claim 21 , wherein the volume of viscoelastic fluid is delivered during advancement of the flexible conduit.
26. The method of claim 21 , wherein the volume of viscoelastic fluid is delivered during retraction of the flexible conduit.
27. The method of claim 21 , wherein the cannula comprises a curved distal portion.
28. The method of claim 21 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
29. The method of claim 21 , wherein the flexible conduit comprises an enlarged atraumatic distal tip.
30. The method of claim 21 , wherein the volume of viscoelastic fluid is about 20 μl to 50 μl.