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, 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 about 8 μl to about 50 μl of viscoelastic fluid to Schlemm's canal to dilate associated collector channels.
2. The method of claim 1 , wherein the device further comprises a cannula coupled to the handle, the conduit slidably positioned within the cannula.
3. The method of claim 1 , wherein the viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
4. The method of claim 1 , wherein the viscoelastic fluid is delivered while moving the conduit.
5. The method of claim 1 further comprising delivering to the eye a second device, wherein the second device disrupts trabecular meshwork.
6. The method of claim 1 further comprising disrupting trabecular meshwork after delivering the about 8 μl to about 50 μl of viscoelastic fluid to Schlemm's canal.
7. The method of claim 1 , wherein the handle further comprises an actuator configured to advance the conduit along the arc of Schlemm's canal, wherein the actuator comprises a slide.
8. The method of claim 1 , wherein delivering the 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, 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 about 8 μl of viscoelastic fluid to Schlemm's canal while retracting the conduit along the arc of Schlemm's canal.
10. The method of claim 9 , wherein the device further comprises a cannula coupled to the handle, wherein the conduit is slidably positioned within the cannula.
11. The method of claim 9 further comprising delivering to the eye an ocular device to improve outflow of aqueous humor after delivering the about 8 μl of viscoelastic fluid.
12. The method of claim 9 , wherein the ocular device is made of a metal or a metal alloy.
13. The method of claim 11 , wherein the ocular device disrupts trabecular meshwork.
14. The method of claim 9 , wherein delivering the viscoelastic fluid comprises pressurizing the fluid reservoir.
15. The method of claim 9 , wherein the viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.
16. 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, 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 about 8 μl of viscoelastic fluid to Schlemm's canal while retracting the conduit along the arc of Schlemm's canal to dilate collector channels associated with Schlemm's canal.
17. The method of claim 16 further comprising, after delivering the viscoelastic fluid, forming one or more holes in trabecular meshwork.
18. The method of claim 16 , wherein the device further comprises a cannula coupled to the handle, wherein the conduit is slidably positioned within the cannula.
19. The method of claim 18 , wherein the conduit comprises a polymer and a metal wire.
20. The method of claim 16 , wherein delivering the viscoelastic fluid comprises pressurizing the fluid reservoir.
21. The method of claim 16 , wherein the conduit comprises an indicator configured to assist in identifying a position of the conduit.
22. The method of claim 16 , wherein the viscoelastic fluid is delivered about at least a 90 degree arc of Schlemm's canal.