Internal shunt and method for treating glaucoma

Abstract

A surgical technique wherein an indwelling shunt is placed in the eye of a patient having glaucoma. The shunt diverts aqueous humor from a deep scleral lake or directly from the anterior chamber to the suprachoroidal space from which it is removed by blood flowing in the choroidal and uveal tissues. This decreases the intra-ocular pressure. The indwelling shunt maintains the area of exposure of aqueous humor with the uvea by physically preventing scarring of the surrounding tissues. The method utilizes the 25 mm Hg driving force of the protein colloidal osmotic pressure of the blood to maximize the flow.

1 . A method of surgically treating glaucoma, comprising the steps of: 
 a) placing a shunt below scleral tissue of an eye in order to divert aqueous humor from a scleral lake to a suprachoroidal space from which said aqueous humor is removed by blood flowing in choroidal and uveal tissues, whereby intra-ocular pressure is reduced;    b) maintaining an area of exposure of said aqueous humor with uveal tissue by physically preventing scarring of surrounding tissues; and    c) utilizing osmotic pressure of the blood to maximize flow of said aqueous humor from said scleral lake.    
   
   
       2 . The method of surgically treating glaucoma in accordance with  claim 1 , wherein said shunt comprises an indwelling shunt remaining within the confines of the globe of said eye.  
   
   
       3 . The method of surgically treating glaucoma in accordance with  claim 1 , wherein said shunt comprises a hollow tube.  
   
   
       4 . The method of surgically treating glaucoma in accordance with  claim 3 , wherein said hollow tube is precut prior to surgery.  
   
   
       5 . The method of surgically treating glaucoma in accordance with  claim 4 , wherein said hollow tube has polished edges.  
   
   
       6 . The method of surgically treating glaucoma in accordance with  claim 4 , wherein said hollow tube has an attached suture and needle for suturing said hollow tube to said scleral tissue.  
   
   
       7 . The method of surgically treating glaucoma in accordance with  claim 1 , wherein said shunt placing step (a) further comprises the step of inserting said shunt into a suprachoroidal space of said eye.  
   
   
       8 . The method of surgically treating glaucoma in accordance with  claim 1 , further comprising the step of: 
 d) suturing said shunt within said eye.    
   
   
       9 . A method of surgically treating glaucoma, comprising the steps of: 
 a) creating a scleral flap in scleral tissue of an eye;    b) performing a deep sclerectomy creating a deep scleral lake;    c) placing a tube-like shunt in a space below said scleral flap;    d) diverting aqueous humor from said deep scleral lake to an adjacent suprachoroidal space;    e) utilizing osmotic pressure of the blood flowing in choroidal and uveal tissues to maximize flow of said aqueous humor from said deep scleral lake to said adjacent suprachoroidal space.    
   
   
       10 . The method of treating glaucoma in accordance with  claim 9 , further comprising the step of: 
 f) maintaining an area of exposure of said aqueous humor with uveal tissue, by physically preventing scarring of surrounding tissues.    
   
   
       11 . The method of surgically treating glaucoma in accordance with  claim 10 , wherein said tube-like shunt comprises a hollow tube with polished edges.  
   
   
       12 . The method of surgically treating glaucoma in accordance with  claim 11 , wherein said hollow tube is precut prior to surgery.  
   
   
       13 . The method of surgically treating glaucoma in accordance with  claim 12 , wherein said hollow tube has polished edges.  
   
   
       14 . The method of surgically treating glaucoma in accordance with  claim 12 , wherein said hollow tube has an attached suture and needle.  
   
   
       15 . The method of surgically treating glaucoma in accordance with  claim 9 , wherein said placing a tube-like shunt step (c) further comprises the step of inserting said tube-like shunt into a suprachoroidal space of said eye.  
   
   
       16 . The method of surgically treating glaucoma in accordance with  claim 9 , further comprising the step of: 
 f) suturing said tube-like shunt within said eye.    
   
   
       17 . A device for the surgical treatment of glaucoma comprising a longitudinal structure comprising biologically compatible material that shunts aqueous humor from a deep scleral lake to the adjacent suprachoroidal space.  
   
   
       18 . The device in accordance with  claim 17 , further comprising an internal shunt remaining within the confines of the globe of an eye.  
   
   
       19 . The device in accordance with  claim 18 , further comprising a hollow tube, precut prior to surgery, wherein said hollow tube has polished edges, and said hollow tube has an attached suture and needle at one end for suturing said hollow tube.  
   
   
       20 . The device in accordance with  claim 18 , further comprising a shunting structure wherein said structure is a grooved material, an open celled foam material, or a porous material.  
   
   
       21 . A method of surgically treating glaucoma, comprising the steps of: 
 a) creating a posterior scleral flap in the scleral tissue of an eye;    b) creating a posterior deep sclerectomy beneath said posterior scleral flap;    c) placing the anterior end of a tube-like shunt in a space below said posterior scleral flap through said scleral tissue into an anterior chamber of said eye;    d) placing the posterior end of said tube-like shunt into a posterior suprachoroidal space;    e) diverting aqueous humor directly from said anterior chamber to said posterior suprachoroidal space via said tube-like shunt from said anterior chamber through said adjacent scleral tissue, under said posterior scleral flap into said posterior suprachoroidal space; and    f) utilizing osmotic pressure of the blood to maximize the flow of said aqueous humor from said posterior suprachoroidal space into blood flowing in choroidal and uveal tissues.    
   
   
       22 . The method of treating glaucoma in accordance with  claim 21 , further comprising the step of: 
 g) maintaining an area of exposure of said aqueous humor with said uveal tissue, by physically preventing scarring of surrounding tissues.    
   
   
       23 . The method of surgically treating glaucoma in accordance with  claim 21 , wherein said tube-like shunt comprises a hollow tube.  
   
   
       24 . The method of surgically treating glaucoma in accordance with  claim 23 , wherein said hollow tube is precut prior to surgery.  
   
   
       25 . The method of surgically treating glaucoma in accordance with  claim 24 , wherein said hollow tube has polished edges.  
   
   
       26 . The method of surgically treating glaucoma in accordance with  claim 25 , wherein said hollow tube has an attached suture and needle in the posterior end of said hollow tube for fixation to said scleral tissue overlying said hollow tube.  
   
   
       27 . The method of surgically treating glaucoma in accordance with  claim 21 , further comprising the step of: 
 g) suturing said tube-like shunt within said eye.    
   
   
       28 . A device for the surgical treatment of glaucoma comprising a longitudinal structure composed of biologically compatible material that shunts aqueous humor from the anterior chamber through the sclera into the suprachoroidal space, without creating a permanent cyclodialysis cleft and disinserting the ciliary body from a scleral spur.  
   
   
       29 . The device in accordance with  claim 28 , wherein said longitudinal structure comprises an internal shunt remaining within the confines of the globe of an eye.  
   
   
       30 . The device in accordance with  claim 29 , further comprising a hollow tube, precut prior to surgery, wherein said hollow tube has polished edges, and said hollow tube has an attached suture and needle at one end for suturing said hollow tube.  
   
   
       31 . The device in accordance with  claim 29 , further comprising a shunting structure wherein said structure is selected from the group: a grooved material, an open celled foam material, and a porous material.  
   
   
       32 . The device in accordance with  claim 31  wherein said structure is precut prior to surgery, and said structure has an attached suture and needle at one end for suturing said structure.