Patent Grant
9084662
This disclosure relates generally to methods and devices for use in treating various ocular diseases. Glaucoma is caused by a number of different eye diseases which can produce increased intraocular pressure (IOP) in the eye. The increased pressure is often caused by a backup of aqueous humour within the eye. Over time, the increased pressure can cause damage to the optic nerve, which can lead to blindness.
One way to treat glaucoma is to implant a drainage device, or shunt, in the eye. The drainage device functions to drain aqueous humour from the anterior chamber and thereby reduce the intraocular pressure. The drainage device is typically implanted using to an invasive surgical procedure. Pursuant to one such procedure, a flap is surgically formed in the sclera. The flap is folded back to form a small cavity and a shunt is inserted into the eye through the flap. Such a procedure can be quite traumatic for the patient.
The following references describe various devices and procedures for treating glaucoma: U.S. Pat. No. 6,827,700 to Lynch, U.S. Pat. No. 6,666,841 to Bergheim, U.S. Pat. No. 6,508,779 to Suson, U.S. Pat. No. 6,544,208 to Ethier, U.S. Pat. No. 5,601,094 to Reiss, U.S. Pat. No. 6,102,045 to Nordquist, United States Patent Application 2002/0156413 to Williams, 2002/0143284 to Tu, 2003/0236483 to Ren, 2002/0193725 to Odrich, 2002/0165478 to Gharib, 2002/0133168 to Smedley, 2005/0107734, 2004/0260228 to Lynch, 2004/0102729 to Haffner, 2004/0015140 to Sheilds, 2004/0254521 to Simon, 2004/0225250 to Yablonski. The aforementioned references are all incorporated herein by reference in their entireties.
Current devices and procedures for treating glaucoma have disadvantages and in some cases only moderate success rates. The procedures are very traumatic to the eye and also require highly accurate surgical skills, such as to properly place the drainage device in a proper location. In addition, the devices that drain fluid from the anterior chamber to a subconjunctival bleb beneath a scleral flap, are prone to infection, and can occlude and cease working. This can require re-operation to remove the device and place another one, or can result in further surgeries. In addition, for agents delivered via direct injection, other complications result, and numerous office visits are required to keep a therapeutic dose resident in the eye. In view of the foregoing, there is a need for improved devices and methods for the treatment of a variety of ocular diseases.
Disclosed are devices and methods for treatment of eye disease such as glaucoma. Using the devices and introduction and placement techniques of the present invention, it is possible to place a device using the suprachoroidal space as a conduit within which to place a drug delivery device. One such drug delivery device may be a tube, wicking element, bioabsorbable polymer structure, or other configuration of drug delivery substrate. The delivery device may include a port on the proximal end to assist in repeat injection, and may include a reservoir at some point along the device to either collect flow from the aqueous to concentrate it along the length of the device, or act as a repository for injected agent.
In addition, the devices of the present invention may be used to augment and assist delivery of drugs to the back of the eye either through injection into a port of the device, or by directing therapeutic agents placed by drops into the eye, but direction the flow of the aqueous containing the drop, into the suprachoroidal space and beyond, to various locations toward the back of the eye.
Placement of a suprachoroidal implant can also assist in delivering drugs to various locations within the eye, including to the back of the eye.
Injections to the back of the eye to treat a wide variety of systemic and ocular conditions such as inflammation, infection, cancerous growth, may be prevented or treated using the drug delivery devices of the present invention. More specifically, ocular conditions such as glaucoma, proliferative vitreoretinopathy, diabetic retinopathy, dry and wet AMD, uveitis, keratitis, cytomegalovirus retinitis, cystoid macular edema, herpes simplex viral and adenoviral infections can be treated or prevented. In many cases, multiple injections are required, leading to degradation of the injection site, and numerous office visits, resulting in increased cost to the healthcare system as well as issues of compliance with patients.
In one aspect, there is disclosed a device for delivering an agent to the eye, comprising an elongate element adapted for at least partial placement in a suprachoroidal space of the eye, the elongate element having a proximal end and a distal end, wherein the proximal end is positioned at a first location of the eye and wherein the distal end extends to a location within a posterior segment of the eye, the elongate element adapted to deliver a drug into the eye.
In another aspect, there is disclosed a method of delivering drug into the eye, comprising: implanting an elongate element in the eye such that at least a portion of the elongate member is positioned within the suprachoroidal space of the eye, the elongate member adapted to deliver a drug into the eye; and inserting a drug into the elongate member such that the drug flows along the elongate member into the suprachoroidal space.
In another aspect, there is disclosed a method of delivering drug into the eye, comprising: forming an incision in the cornea of the eye; inserting an elongate member through the incision into the eye wherein the elongate member is adapted to transport a drug; passing the delivery device along a pathway through the scleral spur of the eye into the suprachoroidal space; and flowing drug along the delivery device into the suprachoroidal space.
In another aspect, there is disclosed a method of delivering drug into the eye, comprising: implanting an elongate element in the eye such that at least a portion of the elongate member is positioned within the suprachoroidal space of the eye, the elongate member adapted to deliver a drug into the eye; placing a drop of a treatment medium onto the surface of the eye; permitting the treatment medium to flow into the anterior chamber of the eye; and causing the treatment medium to flow into the elongate member such that the treatment medium flows along the elongate member into the suprachoroidal space.
Other features and advantages should be apparent from the following description of various embodiments, which illustrate, by way of example, the principles of the invention.
Using the devices and introduction and placement techniques of the present invention, it is possible to place a device that uses the suprachoroidal space as a conduit within which to place a drug delivery device such as the device described herein. One such drug delivery device may be a wicking element, bioabsorbable polymer structure, or other configuration of drug delivery substrate.
One or more drug reservoir regions 2915 may be optionally formed within the suprachoroidal space for receipt of a drug. The drug reservoir region can be a space or volume within the suprachoroidal space into which a drug is inserted. A proximal end or proximal region 2918 of the drug delivery device 2910 can include a port that receives a drug for delivery into the suprachoroidal space, such as into the reservoir region 2915. With the body of the drug delivery device 2910 being anchored within the suprachoroidal space, the distal end and/or the proximal end of the device can be located at various locations relative to the eye to achieve a desired manner of drug delivery, as described below.
The drug delivery device 2910 can have a variety of structures. For example, as shown in
Any of the embodiments of the drug delivery device can include anchoring or retention members, such as fenestrations 2912 on the distal end of the device 2910 in
In an embodiment, the drug delivery device 2910 is adapted to deliver drops placed on the surface of the eye to suprachoroidal space. This is described further detail below with reference to
In another embodiment, a punctal plug is used to deliver a drug to the tear film and into the anterior chamber where the drug intermingles with the aqueous humor. The drug delivery device 29210 then delivers the drug into the suprachoroidal space and possibly to back regions of the eye. Pursuant to such an embodiment, one or more punctal plugs are placed in the eye, such as in the corners of the eye. The punctal plugs can be placed in various regions of the eye, such as in the lower two puncta and/or in the upper puncta. One or more drops of a drug or therapeutic agent are then placed onto the eye such that the drug flows into the anterior chamber via the punctal plugs. The drug then flows into an entry port in the drug delivery device 2910 and flows into the suprachoroidal space via the drug delivery device 2910. International Patent Publication WO 06/014434 to Lazar describes exemplary devices and methods for drug delivery through punctal plugs. That publication is incorporated herein by reference in its entirety.
A wide variety of systemic and ocular conditions such as inflammation, infection, cancerous growth, may be prevented or treated using the drug delivery devices of the present invention. More specifically, ocular conditions such as glaucoma, proliferative vitreoretinopathy, diabetic retinopathy, uveitis, keratitis, cytomegalovirus retinitis, cystoid macular edema, herpes simplex viral and adenoviral infections can be treated or prevented.
Depending on the dose required, and the delivery profile of the agent delivered, it may be advantageous for the drug delivery device to extend from the initial dissection plane at the point of the scleral spur, within the suprachoroidal space to the posterior segment of the eye, or any location therebetween. The geometry of the drug delivery device may assist in the ability to prolong or control various dosing regimes. For example, a longer delivery device may equate to a longer dosing potential, and similarly a larger diameter device may assist with this also. Because the drug delivery device of the present invention completely fills the suprachoroidal space, a “washout” effect may be minimized, thereby also assisting in the dosing. In addition, it may be advantageous to employ a sealant, to seal any communication between the anterior chamber and the newly dissected suprachoroidal space once the drug delivery device is placed. Products such as Tisseal® (Baxter Healthcare, Irvine, Calif.), fibrin glues, or small amounts of cyanoacrylate may be used for this purpose.
Alternatively, if delivery of a therapeutic agent of the present invention is desired in the anterior chamber, or within the sclera, tribecular meshwork, choroid or other structures in proximity to the suprachoroidal space, the entry point at which the delivery device accesses the suprachoroidal space may be varied, such that the distal end of the drug delivery device may be placed in the suprachoroidal space as a means for anchoring the device, and the proximal end (end nearest the outside of the eye) may be placed at the desired delivery location.
With reference to
The drug delivery device 2910 can be positioned within the suprachoroidal space or can have a length such that the distal end of the drug delivery device is positioned at any of a variety of points along the length of the suprachoroidal space, such as any point from the scleral spur to the back regions of the eye.
The proximal end of the drug delivery device 2910 can be positioned at various locations relative to the eye, as shown in
With reference to
With respect to any of the embodiments of
The following classes of drugs could be delivered using the devices of the present invention: anesthetics, analgesics, cell transport/mobility impending agents such as colchicine, vincristine, cytochalasin B and related compounds; antiglaucoma drugs including beta-blockers such as timolol, betaxolol, atenolol, and prostaglandin analogues such as bimatoprost, travoprost, latanoprost etc; carbonic anhydrase inhibitors such as acetazolamide, methazolamide, dichlorphenamide, diamox; and neuroprotectants such as nimodipine and related compounds. Additional examples include antibiotics such as tetracycline, chlortetracycline, bacitracin, neomycin, polymyxin, gramicidin, oxytetracycline, chloramphenicol, gentamycin, and erythromycin; antibacterials such as sulfonamides, sulfacetamide, sulfamethizole and sulfisoxazole; anti-fungal agents such as fluconazole, nitrofurazone, amphotericine B, ketoconazole, and related compounds; anti-viral agents such as trifluorothymidine, acyclovir, ganciclovir, DDI, AZT, foscamet, vidarabine, trifluorouridine, idoxuridine, ribavirin, protease inhibitors and anti-cytomegalovirus agents; antiallergenics such as methapyriline; chlorpheniramine, pyrilamine and prophenpyridamine; anti-inflammatories such as hydrocortisone, dexamethasone, fluocinolone, prednisone, prednisolone, methylprednisolone, fluorometholone, betamethasone and triamcinolone; decongestants such as phenylephrine, naphazoline, and tetrahydrazoline; miotics and anti-cholinesterases such as pilocarpine, carbachol, di-isopropyl fluorophosphate, phospholine iodine, and demecarium bromide; mydriatics such as atropine sulfate, cyclopentolate, homatropine, scopolamine, tropicamide, eucatropine; sympathomimetics such as epinephrine and vasoconstrictors and vasodilators; Ranibizumab, Bevacizamab, and Triamcinolone.
Non-steroidal anti-inflammatories (NSAIDs) may also be delivered, such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors), including a prodrug Nepafenac®; immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Anticlotting agents such as heparin, antifibrinogen, fibrinolysin, anti clotting activase, etc., can also be delivered.
Antidiabetic agents that may be delivered using the present devices include acetohexamide, chlorpropamide, glipizide, glyburide, tolazamide, tolbutamide, insulin, aldose reductase inhibitors, etc. Some examples of anti-cancer agents include 5-fluorouracil, adriamycin, asparaginase, azacitidine, azathioprine, bleomycin, busulfan, carboplatin, carmustine, chlorambucil, cisplatin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daunorubicin, doxorubicin, estramustine, etoposide, etretinate, filgrastin, floxuridine, fludarabine, fluorouracil, fluoxymesterone, flutamide, goserelin, hydroxyurea, ifosfamide, leuprolide, levamisole, lomustine, nitrogen mustard, melphalan, mercaptopurine, methotrexate, mitomycin, mitotane, pentostatin, pipobroman, plicamycin, procarbazine, sargramostin, streptozocin, tamoxifen, taxol, teniposide, thioguanine, uracil mustard, vinblastine, vincristine and vindesine.
Hormones, peptides, nucleic acids, saccharides, lipids, glycolipids, glycoproteins, and other macromolecules can be delivered using the present devices. Examples include: endocrine hormones such as pituitary, insulin, insulin-related growth factor, thyroid, growth hormones; heat shock proteins; immunological response modifiers such as muramyl dipeptide, cyclosporins, interferons (including α, β, and γ interferons), interleukin-2, cytokines, FK506 (an epoxy-pyrido-oxaazcyclotricosine-tetrone, also known as Tacrolimus), tumor necrosis factor, pentostatin, thymopentin, transforming factor beta2, erythropoetin; antineogenesis proteins (e.g., anit VEGF, Interfurons), among others and anticlotting agents including anticlotting activase. Further examples of macromolecules that can be delivered include monoclonal antibodies, brain nerve growth factor (BNGF), celiary nerve growth factor (CNGF), vascular endothelial growth factor (VEGF), and monoclonal antibodies directed against such growth factors. Additional examples of immunomodulators include tumor necrosis factor inhibitors such as thalidomide.
In addition, nucleic acids can also be delivered wherein the nucleic acid may be expressed to produce a protein that may have a variety of pharmacological, physiological or immunological activities. Thus, the above list of drugs is not meant to be exhaustive. A wide variety of drugs or agents may be used in the present invention, without restriction on molecular weight, etc.
Additional examples of beneficial drugs that may be employed in the present invention and the specific conditions to be treated or prevented are disclosed in Remington, supra; The Pharmacological Basis of Therapeutics, by Goodman and Gilman, 19th edition, published by the MacMillan Company, London; and The Merck Index, 13th Edition, 1998, published by Merck & Co., Rahway, N.J., and U.S. Pat. No. 6,331,313 to Wong, which is previously expressly incorporated herein by reference, including the above text.
Although embodiments of various methods and devices are described herein in detail with reference to certain versions, it should be appreciated that other versions, embodiments, methods of use, and combinations thereof are also possible. Therefore the spirit and scope of the appended claims should not be limited to the description of the embodiments contained herein.
Benefit of priority under 35 U.S.C. §119(e) is claimed to U.S. Provisional Application Ser. No. 60/759,835, filed Jan. 17, 2006, entitled “GLAUCOMA TREATMENT DEVICE;” to U.S. Provisional Application Ser. No. 60/783,632, filed Mar. 17, 2006, entitled “GLAUCOMA TREATMENT DEVICE”; and to U.S. Provisional Application Ser. No. 60/824,552, filed Sep. 5, 2006, entitled “GLAUCOMA TREATMENT DEVICE.” The subject matter of each of the above-noted provisional applications and international applications is incorporated by reference in its entirety by reference thereto.
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| 20070233037 A1 | Oct 2007 | US |
| Number | Date | Country | |
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| 60759835 | Jan 2006 | US | |
| 60783632 | Mar 2006 | US | |
| 60824552 | Sep 2006 | US |
