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 of an eye comprising:
advancing a device at least partially through an anterior chamber of the eye and into Schlemm's canal, wherein the device comprises a handle, a fluid reservoir in the handle, and a conduit for delivering a volume of viscoelastic fluid to Schlemm's canal;
advancing the conduit along an arc of Schlemm's canal; and
delivering the volume of viscoelastic fluid to Schlemm's canal, wherein the delivery of the volume of viscoelastic fluid creates microtears in trabecular meshwork.
2. The method of claim 1 , wherein the device further comprises a cannula connected to the handle, and wherein the conduit is slidably positioned within the cannula.
3. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
4. The method of claim 1 , wherein the volume of viscoelastic fluid is delivered while moving the conduit.
5. The method of claim 1 further comprising delivering to the eye a support comprising at least one fenestration, wherein the support disrupts the trabecular meshwork.
6. The method of claim 5 , wherein the support is delivered to the eye after delivering the volume of viscoelastic fluid to Schlemm's canal.
7. The method of claim 5 , wherein the support is made of a metal or a metal alloy.
8. The method of claim 1 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
9. A method for reducing intraocular pressure of an eye comprising:
advancing a device at least partially through an anterior chamber of the eye and into Schlemm's canal, wherein the device comprises a handle, a fluid reservoir in the handle, and a conduit for delivering a volume of viscoelastic fluid to Schlemm's canal;
advancing the conduit along an arc of Schlemm's canal;
delivering the volume of viscoelastic fluid to Schlemm's canal, wherein the delivery of the volume of viscoelastic fluid creates microtears in trabecular meshwork; and
delivering to the eye a support comprising at least one fenestration to improve outflow of aqueous humor.
10. The method of claim 9 , wherein the device further comprises a cannula connected to the handle, wherein the conduit is slidably positioned within the cannula.
11. The method of claim 9 , wherein the volume of viscoelastic fluid is delivered while moving the conduit.
12. The method of claim 9 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
13. The method of claim 9 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
14. The method of claim 9 , wherein the volume of viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
15. The method of claim 9 , wherein the support is made of a metal or a metal alloy.
16. The method of claim 9 , wherein the the support disrupts the trabecular meshwork.
17. A method for treating glaucoma comprising:
advancing a device at least partially through the anterior chamber of the eye and into Schlemm's canal, wherein the device comprises a conduit for delivering a volume of viscoelastic fluid to Schlemm's canal;
advancing the conduit along an arc of Schlemm's canal;
delivering the volume of viscoelastic fluid to Schlemm's canal, wherein the delivery of the volume of viscoelastic fluid creates microtears in trabecular meshwork; and
after delivering the volume of viscoelastic fluid, disrupting the trabecular meshwork to improve flow through the trabeculocanalicular outflow pathway.
18. The method of claim 17 , wherein the device further comprises a handle, a fluid reservoir in the handle, and a cannula connected to the handle, wherein the conduit is slidably positioned within the cannula.
19. The method of claim 18 , wherein the device is a single-handed controlled device.
20. The method of claim 17 , wherein the volume of viscoelastic fluid is delivered while moving the conduit.
21. The method of claim 17 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
22. The method of claim 17 , wherein the volume of viscoelastic fluid is delivered about at least a 180 degree arc of Schlemm's canal.
23. The method of claim 17 , wherein the trabecular meshwork is disrupted with the conduit.
24. The method of claim 17 , wherein the trabecular meshwork is disrupted with an ocular device.
25. A method for treating glaucoma of an eye comprising:
advancing a device at least partially through an anterior chamber of the eye and into Schlemm's canal, wherein the device comprises a conduit for delivering a volume of viscoelastic fluid to Schlemm's canal;
advancing the conduit along an arc of Schlemm's canal;
delivering the volume of viscoelastic fluid to Schlemm's canal wherein the delivery of the volume of viscoelastic fluid creates microtears in trabecular meshwork; and
after delivering the volume of viscoelastic fluid, forming one or more holes in the trabecular meshwork.
26. The method of claim 25 , wherein the device further comprises a handle, a fluid reservoir in the handle, and a cannula connected to the handle, wherein the conduit is slidably positioned within the cannula.
27. The method of claim 26 , wherein the device is a single-handed controlled device.
28. The method of claim 25 , wherein delivering the volume of viscoelastic fluid comprises pressurizing the fluid reservoir.
29. The method of claim 25 , wherein the volume of viscoelastic fluid is delivered while moving the conduit.
30. The method of claim 25 , wherein the volume of viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.