Trabecular Meshwork Cleavage for Low-Trauma Glaucoma Outflow
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Solution Overview
Problem
There is a need for improved, minimally invasive instruments and methods to perform goniotomy-type glaucoma treatments that reduce intraocular pressure with long-lasting effects, minimize follow-up procedures, and reduce the need for medications.
Innovation Solution
A method involving a surgical instrument with a cutting means to sever the anterior attachment of trabecular meshwork and the inner wall of Schlemm's Canal, creating a trabecular meshwork/inner wall leaflet without removing substantial meshwork, and forming a precise cleavage plane that preserves intracanalicular valves and structures.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional goniotomy procedures are performed to cleave trabecular meshwork, then intraocular pressure is reduced, but the procedure requires removal of substantial trabecular meshwork tissue and causes more trauma
Solution Approach 1:
The invention extracts only the necessary attachment portion of the trabecular meshwork from its anterior attachment at Schwalbe's line, rather than removing substantial meshwork tissue. The cutting means selectively severs the anterior attachment while leaving the bulk of the trabecular meshwork intact, thereby reducing tissue loss while achieving the therapeutic effect of IOP reduction.
Solution Approach 2:
The procedure segments the trabecular meshwork treatment into two distinct parts: (1) severing the anterior attachment at Schwalbe's line to create the leaflet, and (2) preserving the main body of the trabecular meshwork with its elastic network. This segmentation allows selective cleavage of only the necessary portion while maintaining the integrity and function of the remaining tissue.
2Productivity
If conventional instruments are used to create passageways in trabecular meshwork, then aqueous outflow is improved, but intracanalicular valves and structures are damaged
Solution Approach 1:
The cutting means is designed to apply local quality differentiation by selectively cutting the anterior attachment portion of the trabecular meshwork while preserving the intracanalicular valves and structures. The instrument's geometry and cutting action are localized to Schwalbe's line region, creating a trabecular meshwork/inner wall of Schlemm's Canal leaflet without extending damage to the valve-containing intracanalicular structures.
3Productivity
If more extensive trabecular meshwork removal is performed, then outflow resistance is reduced, but surgical trauma increases and recovery time extends
Solution Approach 1:
The preserved elastic network of the trabecular meshwork provides self-service functionality by maintaining its natural pumping and filtering actions. By leaving the elastic network intact rather than removing it, the tissue continues to actively regulate aqueous outflow through its inherent physiological mechanisms, reducing the need for extensive surgical intervention and minimizing trauma.
Data Source
AI summary
A method of treating glaucoma in an eye includes obtaining a surgical instrument having a cutting means and severing/cleaving an anterior attachment of a portion of trabecular meshwork of the eye proximate to Schwalbe's line with the cutting means while leaving the ciliary muscle tendons attached to the scleral spur of the portion of trabecular meshwork to create a trabecular meshwork leaflet. The surgical instrument including the cutting means is preferably a handheld microsurgical cutting instrument having at least one sharpened edge. Alternatively, the instrument may be an invasive or non-invasive laser cutting instrument with a laser cutting means; a vibratory cutting instrument with a vibratory cutting means; or a thermal cutting instrument with a thermal cutting means. The step of severing the portion of trabecular meshwork is preferably characterized by a linear cleavage plane severing the attachment portion without removing substantially any trabecular meshwork from the eye.