All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
Corrective eye procedures for improved vision may utilize a small corneal device, which can be too flexible and too small to be properly and reliably manipulated by hand, and which may also be difficult to manipulate with common tools such as tweezers or sinskey hooks.
Some existing system and methods require two hands for deploying a corneal device, with the second hand using a secondary tool to facilitate the deployment of the corneal device from a delivery tool. Mechanical forces used to manipulate the corneal device may damage the corneal device, so using a secondary tool to deploy a corneal device can have disadvantages.
Additionally, depending on the material of the corneal device, the corneal device may need to remain hydrated during storage. Preparing a delivery device and hydrated corneal device for use can cause the corneal device to become disassociated from the delivery device via fluid movement. For example, if parts of a packaging system near the corneal device are moved apart, the movement can cause fluid surface tension to pull the corneal device away from the delivery device, possibly causing loss of the corneal device.
Corneal devices that are hydrogel-based or have features that are small such as diameter, thickness, edge profile, etc. are hard to handle or manipulate by the surgeon or person performing the implantation. The device can become dislocated, bent, curled, scratched, or damaged in general without the use of a convenient well designed ergonomic delivery device.
Additional devices, systems, and methods are needed that can utilize surface tension of a fluid to safely, easily, quickly, and reliably perform at least one of the following: removing a corneal device from packaging and moving at least one support or storage device from an applicator member; and transferring a corneal device from an applicator member to corneal tissue.
Additional devices and system are needed that allow surface tension and capillary forces to retain a corneal device within a small area minimally affected by transportation forces through geometries that are less costly to form, to ensure the corneal device is presented in proper orientation.
One aspect of the disclosure is an elongate corneal device applicator, including a handle and an applicator surface adapted to interface with a surface of a corneal device, the applicator having a longitudinal axis extending along its length, the longitudinal axis passing through the applicator surface.
In a side view, an angle between the longitudinal axis and a plane or axis passing through at least a portion of the applicator surface, optionally at least the periphery of the applicator surface, is greater than 45 degrees, optionally greater than 55 degrees.
The longitudinal axis can pass through a central region of the applicator surface, even if the central region includes or is defined by an aperture in the applicator surface.
The applicator can further comprise a fluid channel extending proximally from an aperture in the applicator surface, the fluid channel being in fluid communication with the external environment that is external to the applicator at a location proximal to the applicator surface.
The applicator surface, even if curved, can have a diameter that is greater than a diameter of the corneal device, but optionally not greater than 2 times the diameter of the corneal device, and optionally not greater than 1.5 times the diameter of the corneal device.
The applicator surface diameter can be less than the outermost dimension (e.g., outer diameter) of the handle region.
The applicator can further include a cap interface that is adapted to interface with a cap and stabilize the relative positions of the applicator and cap. The cap interface can be proximal to the applicator surface.
One aspect of the disclosure is an elongate corneal device applicator, including a handle and an applicator surface adapted to interface with a surface of a corneal device, the applicator having a configuration of a marker, the marker not being a hockey stick configuration.
The applicator can further comprise a fluid channel extending proximally from an aperture in the applicator surface, the fluid channel being in fluid communication with the external environment that is external to the applicator at a location proximal to the applicator surface.
The applicator surface, even if curved, can have a diameter that is greater than a diameter of the corneal device, but optionally not greater than 2 times the diameter of the corneal device, and optionally not greater than 1.5 times the diameter of the corneal device.
The applicator surface diameter can be less than the outermost dimension (e.g., outer diameter) of the handle region.
The applicator can have a cap interface that is adapted to interface with a cap and stabilize the relative positions of the applicator and cap. The cap interface can be proximal to the applicator surface.
One aspect of the disclosure is an elongate corneal device applicator, including a handle and an applicator surface adapted to interface with a surface of a corneal device, the applicator having an elongate configuration other than an “L” configuration and other than a general hockey stick configuration.
One aspect of the disclosure is a cap for a corneal device apparatus, the cap sized and configured to be disposed over a distal end of a corneal device applicator.
The cap can be configured with at least one surface to form a distal end of a corneal device nest, the applicator forming a proximal end of the nest.
The cap can include a plurality of arms partially defining a corneal device nest, optionally wherein the plurality of arms are at least three arms, optionally at least four arms, optionally at least five arms, or optionally at least six arms. The plurality of arms can be disposed at a distal end of the cap. The plurality of arms can be coupled together at their distal ends. Each set of adjacent arms of the plurality of arms can define a plurality of spaces in between each set of adjacent arms. The spaces can be in fluid communication with an internal volume defined by the cap, the internal volume being in communication with a proximal end aperture adapted to receive therein a corneal device applicator. The plurality of arms can extend proximally from the distal end of the cap. The plurality of arms can extend radially outward from where they meet each other, then proximally toward a proximal end of the cap.
The cap can have an internal volume and a proximal end opening sized and configured to receive an applicator member.
The distal end of the cap can have a plurality of apertures therein so that the internal volume is in fluid communication with an external environment distal to the cap.
The cap, in a side view, can have a distal end, optionally defined by a plurality of arms, that is not orthogonal to a longitudinal axis of the cap.
The cap, in an end view of the cap, can have a plurality of apertures each extending through a distally facing surface of the cap, the aperture having general flower petal configurations with rounded outer edges.
The cap can include a distal end region that partially defines a corneal device nest, the distal end region having, in a side view, an outer dimension less than an outer dimension of a proximal end of the cap, optionally with a beveled surface somewhere in between.
One aspect of the disclosure is a corneal device storage and/or positioning system, comprising any of the applicator members described or claimed herein, and any of the caps described or claimed herein.
One aspect of the disclosure is a corneal device storage and/or positioning system, comprising: a corneal device applicator member having a marker configuration; and a cap sized and configured with an internal region or volume to fit completely over and around a distal end of the applicator member, the applicator member and the cap defining a corneal device nest for stabilizing a corneal device therein. The applicator member can be any of the applicator member claimed or described herein. The cap can be any of the caps claimed or described herein.
The disclosure also includes any method of using any of the applicators, caps, or systems herein, as part of a process to prepare for positioning or positioning a corneal device.
The disclosure herein relates generally to devices and systems for at least one of storing a corneal device and positioning a corneal device onto target tissue. It should be noted that the disclosure herein describes the placement of a corneal device (e.g., inlay) as a mere example of how the placement devices can be used. In some embodiments, the device and systems can be used to place a corneal device onto corneal tissue, such as an inlay onto a stromal bed. The disclosure herein generally uses surface tension of a fluid along with pressure differentials to allow simple, reliable and accurate placement of a disk with one hand not otherwise attainable. The capillary and surface tension forces described herein can be used, however, to transport almost any object where precise and reliable placement is desired.
A merely exemplary advantage of devices herein is that the designs allow very minimal water to be introduced onto the corneal device during delivery of the device. This is advantageous when delivering transparent implants because transparent implants are difficult to see. This low water content ensures easy handling and manipulating by the surgeon during centration and desired movement of the implant into position.
Referring generally to
The systems and methods herein can be used with any suitable corneal device, such as any of the corneal devices described in US2011/0218623, which is fully incorporated by reference herein. For example, without limitation, the corneal device can have a diameter between 1-4 mm (e.g., 1-3 mm, or 2 mm), a thickness of 5 microns to 200 microns (e.g., 10 microns—150 microns, or 10 microns—50 microns), and made from a hydrogel material with a water content of at least 50%. Other corneal devices can, however, be stored and/or positioned using the device and/or systems herein.
Referring to
Referring to
The curvature of applicator surface 102 is as close as possible to the curvature of the anterior surface of corneal device 130 (even though there is an aperture in surface 102). The applicator surface 102, when manufactured, can thus be configured to correspond as closely as possible to whatever the curvature is of the intended corneal device 130. In some embodiments the surface 102 has a spherical curvature (excluding the aperture in the central region of surface 102) that corresponds to a spherical anterior surface of a corneal device. The inner surfaces of retaining members 1116 defining the distal end of nest 1114 can similarly have a curved configuration that matches the curvature of a proximal surface of the corneal device. Even though the retaining members 1106 have apertures between them, the inner surfaces of retaining members 1116 can still be considered to have a curvature based on a curve that may be imparted to the distal end of the corneal device nest before further apertures are machined into the cap 110. So even though the distal end of the nest may not define a continuous surface (it has apertures), it can still be considered to have a curvature. Similarly, the anterior end of the nest has a curvature even though an aperture extends therethrough.
The cage region of cap 110 has, in this embodiment, six apertures between retaining members 1106. Those apertures are in fact defined by the surfaces of retaining members 1106. The retaining members are merged together at a central location of the nest, which helps retain the corneal device in the device nest. The apertures are sized to prevent the corneal device from escaping out of the nest through any of the apertures.
In some exemplary embodiments, the system parts are configured and sized such that surface 102 is 100 microns (+/−50 microns) away from the inner surface of retaining members 1106. The distance between surfaces may be chosen based on the thickness of the corneal device.
As discussed above, when cap 110 is removed (pulled off) applicator 100, the corneal device remains adhered to distal tip surface 102 of applicator 100. This is considered to be a preferential adhesion to applicator 100 rather than cap 110. Stated alternatively, the apparatus 10 is adapted and configured so that corneal device 130 will preferentially adhere to distal tip surface 102 of applicator 100, not the cap 110, when cap 110 is pulled off applicator 100 (or applicator 100 is pulled from cap 110. The apertures 1110 reduce the surface area of the distal region of nest adjacent the corneal device 130, which reduces the amount of contact the distal region of the nest (i.e., the cap) has with the corneal device 130. Having a system 10 in which corneal device 130 has less contact with cap 110 than applicator 100 helps the corneal device 130 preferentially adhere to applicator tip surface 102 when cap 110 is removed from the applicator 100. The concept of preferential adhesion is described more fully in WO2016/028275, the description of which is incorporated by reference herein.
It was observed through testing that prior to the removal of retaining cap 110, fluid did not need to be removed, or wicked away, in order for corneal device (130) to remain on the distal tip of applicator (100) after retaining cap 110 was pulled away. This eliminates an additional wicking step during the placement procedure, thereby making the overall process more efficient. Referring to the exemplary method of placement shown in the sequential
Referring to
Some earlier applicator devices include a distal bend, such that the device approximates the configuration of a standard hockey stick (the lower portion and handle defining an angle that is 90 degrees or more). The applicators herein do not have this general hockey stick configuration, but rather have a “marker” configuration. That is, the applicators herein are elongate and do not have a distal bend near the distal end. This allows the applicator members to be held and used in virtually the same way as one would contact a marker with a piece of paper. Another way of describing the shape is that the applicator member, which includes a handle region and applicator surface, has a longitudinal axis (see axis LA in
P exists even though surface 102 has a curved configuration. Plane P is essentially passing through the outer periphery of surface 102, even if plane P does not pass through the entire surface 102 (since surface 102 is curved). Cap 110 is sized and configured to be positioned around the distal end of applicator 110.
The system may also include a marker (which may be sealing) cap, such as cap 120 shown in
Through at least one or more of unequal surface areas (described above), capillary tube (described above) and the natural change of volume leading to negative pressures (described above), the devices herein provide for the quick and reliable transfer of a corneal device with fewer required steps and lower manufacturing costs.
Any of the systems and applicator members described herein, such as shown in
This application claims priority to U.S. Patent Application 62/524,201, filed Jun. 23, 2017, which is incorporated by reference herein. This application is related to U.S. Pat. No. 6,581,993 and WO2016/028275, which are incorporated by reference herein in their entireties.
Filing Document | Filing Date | Country | Kind |
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PCT/US2018/038925 | 6/22/2018 | WO | 00 |
Number | Date | Country | |
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62524201 | Jun 2017 | US |