Minimally invasive glaucoma surgical instrument and method
Apparatuses and methods for the treatment of glaucoma are provided. The instrument uses either cauterization, a laser to ablate, sonic or ultrasonic energy to emulsify, or mechanical cutting of a portion of the trabecular meshwork. The instrument may also be provided with irrigation, aspiration, and a footplate. The footplate is used to enter Schlemm's canal, serves as a guide, and also protects Schlemm's canal.
1. A device useable for removing trabecular meshwork tissue from the eye of a subject, said device comprising:
an elongate probe comprising a probe shaft having a distal end, a hollow inner chamber and an opening near its distal end;
a movable cutter disposed within the hollow inner chamber; and
a member extending at an angle from the distal end of the probe shaft, said member having a tip, an upper side and a lower side, the opening being located adjacent to the upper side of the member;
the probe shaft being insertable into the anterior chamber of the eye and the distal tip of the member being thereafter advanceable through the trabecular meshwork thereby positioning the member in Schlemm's canal with an opposing wall of Schlemm's canal juxtaposed to the lower side of the member and trabecular meshwork tissue juxtaposed to the upper side of the member; and
the moveable cutter being operable to sever trabecular meshwork tissue that passes through the opening.
2. A device according to claim 1 wherein the member is configured so as to be advanceable through Schlemm's canal in a manner that causes trabecular meshwork tissue to ride over the upper side of the member and through the opening.
3. A device according to claim 1 further comprising an aspiration lumen useable for aspirating trabecular meshwork tissue through the opening.
4. A device according to claim 3 further comprising an aspiration pump that is attachable to the aspiration lumen.
5. A device according to claim 4 wherein the aspiration pump draws trabecular meshwork tissue through the opening so that it is severed by the moveable cutter while the probe is held stationary.
6. A device according to claim 3 wherein the aspiration lumen is useable for removal of trabecular meshwork tissue that has passed through the opening-and been severed by the moveable cutter.
7. A device according to claim 1 wherein the moveable cutter rotates.
8. A device according to claim 7 wherein the moveable cutter comprises a rotating cutting head.
9. A device according to claim 7 wherein a rotating drive member extends through the probe shaft to rotationally drive the moveable cutter.
10. A device according to claim 1 wherein the moveable cutter reciprocates longitudinally.
11. A device according to claim 10 wherein the moveable cutter comprises a cutting sleeve.
12. A device according to claim 10 wherein a drive member or mechanism extends through the probe shaft for driving the moveable cutter in reciprocating longitudinal motion.
13. A device according to claim 12 wherein the drive member or mechanism comprises a rotating drive mechanism that causes the cutting sleeve to reciprocate longitudinally.
14. A device according to claim 1 wherein the lower side of the member extends substantially perpendicular to the probe shaft.
15. A device according to claim 1 further comprising an irrigation lumen with an irrigation fluid outlet opening.
16. A device according to claim 1 wherein the member has a plate shape.
17. A device according to claim 1 wherein the upper side of the member slopes upwardly from the tip toward the shaft.
18. A device according to claim 1 wherein the lower side of the member has a transversely arcuate shape.
19. A method for removing trabecular meshwork tissue from the eye of a subject, said method comprising the steps of:
A) obtaining or providing a device that comprises i) an elongate probe comprising a probe shaft having a distal end, a hollow inner chamber and an opening near its distal end; ii) a moveable cutter positioned within the hollow inner chamber; and iii) a member which extends at an angle from the distal end of the probe shaft, said member having a tip, an upper side and a lower side, wherein the opening in the shaft is adjacent to the upper side of the member and the moveable cutter is operable to sever trabecular meshwork tissue that passes through the opening;
B) inserting the probe shaft into the anterior chamber of the eye;
C) advancing the tip of the member through the trabecular meshwork and inserting the member in Schlemm's canal such that an outer wall of Schlemm's canal is in juxtaposition to the lower side of the member and trabecular meshwork tissue in juxtaposition to the upper side of the member;
D) causing the moveable cutter to move; and
E) advancing the member through Schlem's Canal such that trabecular meshwork tissue rides over the upper surface of the member, passes through the opening and is severed by the moveable cutter.
20. A method according to claim 19 wherein the upper side of the member slopes upwardly from the tip toward the shaft and, in Step E, the trabecular meshword tissue is elevated as it rides over the upward sloping upper surface of the member before passing through the opening and being severed by the moveable cutter.
21. A method according to claim 19 wherein Step E further comprises aspirating trabecular meshwork tissue through the opening.
22. A method according to claim 21 wherein trabecular meshwork tissue is aspirated through the opening while the probe remains substantially stationary.
23. A method according to claim 19 wherein the moveable cutter is rotatable and wherein Step E comprises rotating the moveable cutter.
24. A method according to claim 19 wherein the moveable cutter moves longitudinally and wherein Step D comprises causing the moveable cutter to undergo reciprocating longitudinal movement.
25. A method according to claim 24 herein the moveable cutter comprises a cutting sleeve that moves longitudinally back and forth thereby severing the trabecular meshwork tissue in guillotine fashion.
26. A method according to claim 19 wherein the member has a plate shape.
27. A method according to claim 19 wherein the tip of the tip of the member comprises a tapered tissue-penetrating tip.
28. A method according to claim 27 wherein Step C comprises initially inserting the tapered tissue-penetrating tip through the trabecular meshwork and then advancing the remainder of the member into Schlemm's canal so that the outer wall of Schlemm's canal is in juxtaposition to the lower side of the member and trabecular meshwork tissue in juxtaposition to the upper side of the member.
29. A method according to claim 19 wherein the lower side of the member has a transversely arcuate shape.
30. A method according to claim 29 wherein, in Step C, the transversely arcuate lower surface of the member is placed in juxtaposition to the opposing wall of Schlemm's canal.