DEVICES AND METHODS FOR INTRAOCULAR TISSUE MANIPULATION
Provided herein are methods and devices for grasping and/or tearing trabecular meshwork of an eye of a subject. The devices may include a shaft and a tissue grabber coupled to the shaft. The tissue grabber may include an elongate lower foot configured to be inserted into Schlemm's canal, and a groove configured to grasp a portion of the trabecular meshwork. The methods may include: advancing a tissue grabber to Schlemm's canal of the eye, wherein the tissue gripper comprises a lower foot and a tissue grabbing region; advancing a tip of the lower foot through the trabecular meshwork and into Schlemm's canal; and advancing the lower foot within and relative to Schlemm's canal, wherein as the lower foot is advanced, a portion of the trabecular enters the tissue gripping region, is torn from surrounding tissue, and is collected within the tissue gripping region.
1 - 39 . (canceled)
40 . A method of tearing trabecular meshwork of an eye of a subject, the method comprising:
advancing a tissue grabber at a distal end of a shaft to Schlemm's canal of the eye, wherein the tissue grabber comprises a lower foot and a groove;
advancing a tip of the lower foot through the trabecular meshwork and into Schlemm's canal; and
advancing the lower foot within and relative to Schlemm's canal, wherein as the lower foot is advanced, a first central portion of the trabecular meshwork becomes trapped in the groove and a second, lateral portion of the trabecular meshwork is detached from surrounding tissue.
41 . The method of claim 40 , wherein the portion of the trabecular meshwork is detached from Schwalbe's line and the scleral spur.
42 . The method of claim 40 comprising withdrawing the tip from Schlemm's canal, thereby withdrawing the detached portion of the trabecular meshwork along with the tissue grabber.
43 . The method of claim 40 , wherein as the lower foot is advanced further within Schlemm's canal, a detached portion of the trabecular forms a ribbon trailing the first portion of the trabecular meshwork trapped in the groove.
44 . The method of claim 43 , further comprising rotating the tip along a longitudinal axis of the shaft before withdrawing the tip from the eye, thereby wrapping the detached portion of the trabecular meshwork around the shaft.
45 . The method of claim 40 , wherein the lower foot is advanced within and relative to Schlemm's canal for between about 30 degrees and about 120 degrees around a circumference of the canal in a first direction.
46 . The method of claim 45 , further comprising removing the lower foot from the canal, rotating the device along a longitudinal axis of the shaft about 180 degrees so that the lower foot is pointed in an opposite direction, re-entering the canal, and advancing the lower foot within and relative to Schlemm's canal in a second, opposite direction.
47 . The method of claim 46 , wherein the lower foot is advanced within and relative to Schlemm's canal for between about 30 degrees and about 120 degrees around the circumference of the canal in the second direction.
48 . The method of claim 40 , wherein the subject is suffering from high intraocular pressure.
49 . The method of claim 48 , wherein the high intraocular pressure is caused by glaucoma.
50 . The method of claim 40 performed as a standalone procedure.
51 . The method of claim 40 , wherein the method is performed in conjunction with cataract removal, canaloplasty, or another glaucoma treatment procedure.
52 . The method of claim 51 , wherein the glaucoma treatment procedure is selected from the group consisting of: deployment of a trabecular microbypass stent or scaffold, deployment of a suprachoroidal shunt, placement of a sustained release glaucoma pharmaceutical implant, and endoscopic cyclophotocoagulation.
53 . The method of claim 40 , wherein the tissue grabber is bladeless.
54 . The method of claim 40 , wherein the tissue grabber is coupled to a distal end of a shaft.
55 . The method of claim 54 , wherein the lower foot comprising a central longitudinal axis that is transverse to a longitudinal axis of the shaft.
56 . The method of claim 40 , wherein the groove has a variable height.
57 . The method of claim 40 , wherein the groove comprises a closed back, and the closed back is rounded.
58 . The method of claim 57 wherein a radius of curvature of the closed back of the groove is at least 10 microns, at least 15 microns, at least 20 microns, about 10 microns, about 15 microns, or about 20 microns.
59 . The method of claim 40 , wherein the tissue grabber comprises an upper foot and the groove is formed between the lower foot and the upper foot.
60 . The method of claim 59 , wherein a length of the lower foot is greater than a length of the upper foot.
61 . The method of claim 59 , wherein a maximum width of the upper foot is greater than a maximum width of the lower foot.
62 - 100 . (canceled)