Schlemm's Canal Excision Tool for Circumferential Meshwork Removal
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Solution Overview
Problem
Current surgical methods for glaucoma, such as Gonioscopy Assisted Transluminal Trabeculotomy (GATT) and Kahook dual blade, face challenges like scarring, fibrosis, reclosure of clefts, and difficulty in controlling exact location during trabecular meshwork removal, which affect the efficacy of intraocular pressure (IOP) lowering.
Innovation Solution
An ophthalmic tool comprising an excise device with a flexible pullstring is used to circumferentially remove trabecular meshwork and Schlemm's canal inner wall, ensuring precise and complete removal through a surgical method involving corneal incisions and threading the tool around the Schlemm's canal.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If GATT procedure is used to dilate or stent Schlemm's canal, then IOP lowering is achieved, but tissue scarring and fibrosis occur leading to reclosure
Solution Approach 1:
The patent removes the problematic trabecular meshwork tissue entirely through the excise device with knife blades, rather than attempting to dilate or stent it in place. This extraction approach eliminates the source of scarring and fibrosis while maintaining the patent's IOP lowering efficacy.
Solution Approach 2:
Instead of trying to preserve and enhance the natural drainage system through dilation or stenting, the patent inverts the approach by removing the obstructive tissue entirely. This creates a permanent open pathway that prevents reclosure, addressing the harmful reclosure issue while maintaining reliable IOP control.
2Quantity of substance
If Kahook dual blade is used to remove trabecular meshwork, then partial tissue removal is achieved, but control of exact location is challenging
Solution Approach 1:
The patent introduces a guide catheter as an intermediary device that provides precise positioning and guidance for the excise device. The guide catheter ensures the excise device is accurately positioned within Schlemm's canal before tissue removal, achieving both complete tissue removal and precise location control.
Solution Approach 2:
The patent segments the surgical procedure into distinct steps: first positioning the guide catheter, then inserting the excise device through the catheter, and finally removing the trabecular meshwork. This segmentation allows for precise control at each stage, particularly in positioning the excise device at the exact location within Schlemm's canal.
3Stability of the object's composition
If conventional outflow system is preserved, then natural drainage is maintained, but flow resistance remains elevated in glaucoma
Solution Approach 1:
The patent extracts the obstructive trabecular meshwork tissue from the drainage pathway, removing the source of elevated flow resistance while preserving the rest of the natural outflow system. This selective removal maintains drainage system integrity while dramatically improving drainage efficiency and lowering IOP.
Data Source
AI summary
Embodiments pertain to an ophthalmic tool for ab-interno removal of ophthalmic tissue from a human eye, the human eye including trabecular meshwork tissue and a Schlemm's canal. The tool comprises an excise device having a longitudinal centerline, and shaped and dimensioned pull-string for snug insertion into the Schlemm's canal, and has a leading nose, and a trailing knife support with a pair of spaced apart longitudinally directed knife blades mounted upright on the knife support.