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 the trabecular meshwork and 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
1Stress or pressure
If traditional goniotomy procedures are performed to cleave trabecular meshwork, then intraocular pressure is reduced, but extensive disruption of microscopic support structures occurs
Solution Approach 1:
The procedure segments the trabecular meshwork into specific portions that are cleaved (anterior attachment and inner wall of Schlemm's canal) while preserving other portions. This selective segmentation allows pressure reduction through controlled tissue division while maintaining structural integrity of critical support elements.
Solution Approach 2:
The invention applies different treatments to different local regions of the trabecular meshwork. The anterior attachment and inner wall are cleaved to improve flow, while the elastic network and microscopic support structures are preserved. This localized approach ensures that pressure reduction is achieved without compromising essential structural support.
2Quantity of substance
If invasive laser ablation instruments are used to form artificial passageways, then aqueous flow is improved, but trauma to eye structures increases
Solution Approach 1:
The invention replaces invasive mechanical laser ablation with a less traumatic approach. Instead of using high-energy laser beams that cause thermal damage, the procedure employs mechanical cleavage of specific tissue portions, which is more controlled and causes less collateral trauma to surrounding eye structures.
Solution Approach 2:
The procedure extracts or removes only the specific problematic portions of the trabecular meshwork (anterior attachment and inner wall) that are preventing adequate aqueous flow. This selective extraction improves flow dynamics while minimizing removal of healthy tissue and reducing overall trauma compared to more aggressive ablation techniques.
3Quantity of substance
If non-invasive laser ablation is used to form artificial passageways, then aqueous flow is improved, but precision in preserving intracanalicular valves is reduced
Solution Approach 1:
The procedure segments the trabecular meshwork treatment into distinct zones: the anterior attachment and inner wall are cleaved to improve flow, while the region containing the intracanalicular valves is specifically preserved. This spatial segmentation allows simultaneous achievement of improved aqueous flow and precise preservation of delicate valve structures.
Solution Approach 2:
Different local qualities are applied to different regions: aggressive cleavage in the anterior region for flow improvement, and gentle preservation in the region containing the intracanalicular valves. This localized differential treatment ensures both functional improvement and structural precision.
4Quantity of substance
If substantial trabecular meshwork is removed to improve outflow, then aqueous drainage is enhanced, but structural support of the eye is compromised
Solution Approach 1:
The procedure extracts only the specific portions of trabecular meshwork that are obstructing aqueous outflow (anterior attachment and inner wall of Schlemm's canal). By removing only these problematic segments rather than substantial portions of the meshwork, adequate drainage enhancement is achieved while preserving the structural support function of the remaining meshwork and elastic network.
Solution Approach 2:
The invention applies local quality differentiation by treating only specific regions of the trabecular meshwork with cleavage while preserving other regions for structural support. The anterior attachment and inner wall are modified for improved flow, while the bulk of the meshwork and elastic network maintain their structural integrity and support function.
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.