Treatment of ocular disease

Abstract

The invention relates to a novel apparatus for the treatment of ocular disease, particularly glaucoma. The apparatus consists of a locating device to locate Schlemm's Canal within the anterior portion of the eye and a surgical tool to access the canal for treatment. The apparatus allows for guided, minimally invasive surgical access to Schlemm's Canal to enable surgical procedures to be performed on the canal and trabecular meshwork to reduce intraocular pressure. The apparatus may also deliver devices or substances to Schlemm's Canal in the treatment of glaucoma.

What is claimed is:  
     
         1 . An apparatus for treating ocular disease comprising: a locating means for non-invasively locating Schlemm's Canal in an eye, and a microsurgical device coupled with the locating means so as to advance the microsurgical device into a tissue space identified with Schlemm's Canal.  
     
     
         2 . The apparatus of  claim 1 , wherein the microsurgical device is under control by the locating means.  
     
     
         3 . The apparatus of  claim 1 , wherein the locating means comprises a device for ultrasound examination of the sclera.  
     
     
         4 . The apparatus of  claim 1 , wherein the locating means comprises an ultrasound imaging system.  
     
     
         5 . The apparatus of  claim 1 , wherein the locating means comprises a non-imaging ultrasound detection system.  
     
     
         6 . The apparatus of  claim 1 , wherein the locating means comprises an ultrasound device for examination of the sclera with an ultrasound frequency greater than  10  MHz.  
     
     
         7 . The apparatus of  claim 1 , wherein the locating means comprises an ultrasound device for examination of the sclera with an ultrasound frequency of at least  40  MHz.  
     
     
         8 . The apparatus of  claim 3 , wherein the locating means utilizes an ultrasound contrast tracer introduced into the aqueous humor.  
     
     
         9 . The apparatus of  claim 1 , wherein the locating means comprises a non-imaging ultrasound device for examination of the sclera.  
     
     
         10 . The apparatus of  claim 9 , wherein the locating means comprises a transducer assembly with signaling means for directing the transducer location.  
     
     
         11 . The apparatus of  claim 1 , wherein the locating means comprises an optical imaging device for non-invasively locating Schlemm's Canal in the eye.  
     
     
         12 . The apparatus of  claim 11 , wherein the optical imaging device comprises a high intensity white light illumination source.  
     
     
         13 . The apparatus of  claim 11 , wherein the optical imaging device comprises an optically coherent illumination source.  
     
     
         14 . The apparatus of  claim 11 , wherein the optical imaging device comprises a fiber optic device.  
     
     
         15 . The apparatus of  claim 11 , wherein the optical imaging device utilizes detection via visible wavelengths of light.  
     
     
         16 . The apparatus of  claim 11 , wherein the optical imaging device utilizes detection via infrared wavelengths .  
     
     
         17 . The apparatus of  claim 11 , wherein the optical imaging device utilizes optical imaging of a fluorescent tracer in the aqueous humor.  
     
     
         18 . The apparatus of  claim 1 , wherein a tissue contacting surface of the locating means is curved to approximate the surface of the eye.  
     
     
         19 . The apparatus of  claim 1 , wherein a tissue contacting surface of the locating means incorporates a circumferential raised portion to maintain placement of a coupling fluid over a transducer face to aid in energy transfer between the locating means and the tissue surface.  
     
     
         20 . An apparatus for treating ocular disease comprising: a non-invasive locating means for locating Schlemm's Canal in the eye, and a microcannula coupled with the locating means so as to slidably advance into a tissue space identified with Schlemm's Canal.  
     
     
         21 . The apparatus of  claim 20 , wherein the microcannula has an outer diameter of less than 200 microns.  
     
     
         22 . The apparatus of  claim 20 , wherein the microcannula is coupled to the locating means at an angle between 0 and 30 degrees from the plane of Schlemm's Canal in the eye.  
     
     
         23 . The apparatus of  claim 20 , wherein an angle of the microcannula with respect to the locating means is adjustable.  
     
     
         24 . The apparatus of  claim 20 , wherein the locating means and the microcannula are disposed within a unitary body.  
     
     
         25 . The apparatus of  claim 20 , wherein the microcannula is coupled to the locating means by way of a clip mechanism.  
     
     
         26 . The apparatus of  claim 20 , wherein a distal portion of the microcannula is curved to accommodate a curvature of Schlemm's Canal.  
     
     
         27 . The apparatus of  claim 20 , wherein the microcannula incorporates a cutting tip to penetrate a sclera of the eye.  
     
     
         28 . The apparatus of  claim 20 , wherein the microcarmula is comprised of an outer sheath and an inner cannula.  
     
     
         29 . The apparatus of  claim 28 , wherein the inner cannula incorporates a cutting tip to penetrate a sclera of the eye.  
     
     
         30 . The apparatus of  claim 29 , wherein the outer sheath is comprised of a rigid tube.  
     
     
         31 . The apparatus of  claim 29 , wherein the outer sheath is comprised of a flexible tube.  
     
     
         32 . An apparatus for treating ocular disease comprising: 
 a non-invasive locating means for locating Schlemm's Canal,    a microcannula which is linked with the locating means to advance the microcannula into an identified tissue space for Schlemm's Canal, and    a dilation mechanism at the tip of the microcannula.    
     
     
         33 . The apparatus of  claim 32 , wherein the dilation mechanism is comprised of an expandable balloon.  
     
     
         34 . The apparatus of  claim 32 , wherein the dilation mechanism is comprised of an expandable tip on the microcannula.  
     
     
         35 . The apparatus of  claim 32 , wherein the dilation mechanism is comprised of a series of nested cannulae having successively larger diameters.  
     
     
         36 . The apparatus of  claim 32 , wherein the dilation mechanism is comprised of an elongate rod having steps of successively increasing diameters.  
     
     
         37 . The apparatus of  claim 32 , wherein the microcannula is coupled coaxially with the locating means.  
     
     
         38 . An apparatus for treating ocular disease comprising: 
 a non-invasive locating means for locating Schlemm's Canal,    a microcannula which is linked with the locating means to advance the microcannula into an identified tissue space for Schlemm's Canal, and    an implant which is delivered into Schlemm's Canal.    
     
     
         39 . The apparatus of  claim 38 , wherein the implant comprises an expandable stent.  
     
     
         40 . The apparatus of  claim 38 , wherein the implant comprises microparticles.  
     
     
         41 . The apparatus of  claim 38 , wherein the implant comprises a drug releasing material.  
     
     
         42 . The apparatus of  claim 38 , wherein the stent comprises a biodegradable material.  
     
     
         43 . The apparatus of  claim 40 , wherein the microparticles comprise a biodegradable material.  
     
     
         44 . The apparatus of  claim 41 , wherein the drug releasing material contains a drug effective in the treatment of glaucoma.  
     
     
         45 . An apparatus for treating ocular disease comprising: 
 a non-invasive locating means for locating Schlemm's Canal,    a microcannula which is linked with the locating means to advance the microcannula into an identified tissue space for Schlemm's Canal, and    a construct which is delivered through the microcannula to effect a surgical procedure on a trabecular meshwork of the eye.    
     
     
         46 . The apparatus of  claim 45 , wherein the construct comprises a surgical tool for cutting tissues.  
     
     
         47 . The apparatus of  claim 45 , wherein the construct comprises a fiber optic device.  
     
     
         48 . The apparatus of  claim 47 , wherein the fiber optic device is an imaging fiber.  
     
     
         49 . The apparatus of  claim 47 , wherein the fiber optic device is an illuminating fiber.  
     
     
         50 . A method for surgically accessing Schlemm's Canal for treating ocular disease, comprising: 
 locating Schlemm's Canal in an eye via non-invasive means;    advancing a minimally invasive surgical device into the canal guided by the locating means;    delivering a substance for the treatment of the ocular disease.    
     
     
         51 . The method of  claim 50 , wherein Schlemm's Canal is located using ultrasound imaging.  
     
     
         52 . The method of  claim 50 , wherein Schlemm's Canal is located using optical means.  
     
     
         53 . The method of  claim 50 , wherein ultrasound imaging is utilized.  
     
     
         54 . The method of  claim 50 , wherein non-imaging ultrasound guidance is utilized.  
     
     
         55 . The method of  claim 52 , wherein high intensity white light is utilized.  
     
     
         56 . The method of  claim 52 , wherein a coherent light source is utilized.  
     
     
         57 . The method of  claim 52 , wherein visible light detection is utilized.  
     
     
         58 . The method of  claim 52 , wherein infrared light detection is utilized.  
     
     
         59 . The method of  claim 50 , wherein the surgical device is a cannula between 50 and 250 microns in diameter.  
     
     
         60 . The method of  claim 50 , wherein the substance is a viscoelastic material.  
     
     
         61 . The method of  claim 50 , wherein the substance is a gas.  
     
     
         62 . The method of  claim 50 , wherein the substance is a fluorocarbon compound.  
     
     
         63 . The method of  claim 50 , wherein the substance comprises a drug releasing substance.