The present invention is generally directed to a surgical treatment for glaucoma, and relates more particularly to a device and method for continuously decompressing elevated intraocular pressure in eyes affected by glaucoma by diverting aqueous humor from the anterior chamber of the eye into Schlemm's canal where post-operative patency can be maintained with an indwelling shunt which can be surgically placed to connect the canal with the anterior chamber.
Glaucoma is a significant public health problem, because glaucoma is a major cause of blindness. The blindness that results from glaucoma involves both central and peripheral vision and has a major impact on an individual's ability to lead an independent life.
Glaucoma is an optic neuropathy (a disorder of the optic nerve) that usually occurs in the setting of an elevated intraocular pressure. The pressure within the eye increases and this is associated with changes in the appearance (“cupping”) and function (“blind spots” in the visual field) of the optic nerve. If the pressure remains high enough for a long enough period of time, total vision loss occurs. High pressure develops in an eye because of an internal fluid imbalance.
The eye is a hollow structure that contains a clear fluid called “aqueous humor.” Aqueous humor is formed in the posterior chamber of the eye by the ciliary body at a rate of about 2.5 microliters per minute. The fluid, which is made at a fairly constant rate, then passes around the lens, through the pupillary opening in the iris and into the anterior chamber of the eye. Once in the anterior chamber, the fluid drains out of the eye through two different routes. In the “uveoscleral” route, the fluid percolates between muscle fibers of the ciliary body. This route accounts for approximately ten percent of the aqueous outflow in humans. The primary pathway for aqueous outflow in humans is through the “canalicular” route that involves the trabecular meshwork and Schlemm's canal.
The trabecular meshwork and Schlemm's canal are located at the junction between the iris and the sclera. This junction or corner is called “the angle.” The trabecular meshwork is a wedge-shaped structure that runs around the circumference of the eye. It is composed of collagen beams arranged in a three-dimensional sieve-like structure. The beams are lined with a monolayer of cells called trabecular cells. The spaces between the collagen beams are filled with an extracellular substance that is produced by the trabecular cells. These cells also produce enzymes that degrade the extracellular material. Schlemm's canal is adjacent to the trabecular meshwork. The outer wall of the trabecular meshwork coincides with the inner wall of Schlemm's canal. Schlemm's canal is a tube-like structure that runs around the circumference of the cornea. In human adults, Schlemm's Canal is believed to be divided by septa into a series of autonomous, dead-end canals.
The aqueous fluid travels through the spaces between the trabecular beams, across the inner wall of Schlemm's canal into the canal, through a series of about 25 collecting channels that drain from Schlemm's canal and into the episcleral venous system. In a normal situation, aqueous production is equal to aqueous outflow and intraocular pressure remains fairly constant in the 15 to 21 mmHg range. In glaucoma, the resistance through the canalicular outflow system is abnormally high.
In primary open angle glaucoma, which is the most common form of glaucoma, the abnormal resistance is believed to be along the outer aspect of trabecular meshwork and the inner wall of Schlemm's canal. It is believed that an abnormal metabolism of the trabecular cells leads to an excessive build up of extracellular materials or a build up of abnormally “stiff” materials in this area. Primary open angle glaucoma accounts for approximately eighty-five percent of all glaucoma. Other forms of glaucoma (such as angle closure glaucoma and secondary glaucomas) also involve decreased outflow through the canalicular pathway but the increased resistance is from other causes such as mechanical blockage, inflammatory debris, cellular blockage, etc.
With the increased resistance, the aqueous fluid builds up because it cannot exit fast enough. As the fluid builds up, the intraocular pressure (IOP) within the eye increases. The increased IOP compresses the axons in the optic nerve and also may compromise the vascular supply to the optic nerve. The optic nerve carries vision from the eye to the brain. Some optic nerves seem more susceptible to IOP than other eyes. While research is investigating ways to protect the nerve from an elevated pressure, the only therapeutic approach currently available in glaucoma is to reduce the intraocular pressure.
The clinical treatment of glaucoma is approached in a step-wise fashion. Medication often is the first treatment option. Administered either topically or orally, these medications work to either reduce aqueous production or they act to increase outflow. Currently available medications have many serious side effects including: congestive heart failure, respiratory distress, hypertension, depression, renal stones, aplastic anemia, sexual dysfunction and death. Compliance with medication is a major problem, with estimates that over half of glaucoma patients do not follow their correct dosing schedules.
When medication fails to adequately reduce the pressure, laser trabeculoplasty often is performed. In laser trabeculoplasty, thermal energy from a laser is applied to a number of noncontiguous spots in the trabecular meshwork. It is believed that the laser energy stimulates the metabolism of the trabecular cells in some way, and changes the extracellular material in the trabecular meshwork. In approximately eighty percent of patients, aqueous outflow is enhanced and IOP decreases. However, the effect often is not long lasting and fifty percent of patients develop an elevated pressure within five years. The laser surgery is not usually repeatable. In addition, laser trabeculoplasty is not an effective treatment for primary open angle glaucoma in patients less than fifty years of age, nor is it effective for angle closure glaucoma and many secondary glaucomas.
If laser trabeculoplasty does not reduce the pressure enough, then filtering surgery is performed. With filtering surgery, a hole is made in the sclera and angle region. This hole allows the aqueous fluid to leave the eye through an alternate route.
The most commonly performed filtering procedure is a trabeculectomy. In a trabeculectomy, a posterior incision is made in the conjunctiva, the transparent tissue that covers the sclera. The conjunctiva is rolled forward, exposing the sclera at the limbus. A partial thickness scleral flap is made and dissected half-thickness into the cornea. The anterior chamber is entered beneath the scleral flap and a section of deep sclera and trabecular meshwork is excised. The scleral flap is loosely sewn back into place. The conjunctival incision is tightly closed. Post-operatively, the aqueous fluid passes through the hole, beneath the scleral flap and collects in an elevated space beneath the conjunctiva. The fluid then is either absorbed through blood vessels in the conjunctiva or traverses across the conjunctiva into the tear film.
Trabeculectomy is associated with many problems. Fibroblasts that are present in the episclera proliferate and migrate and can scar down the scleral flap. Failure from scarring may occur, particularly in children and young adults. Of eyes that have an initially successful trabeculectomy, eighty percent will fail from scarring within three to five years after surgery. To minimize fibrosis, surgeons now are applying antifibrotic agents such as mitomycin C (MMC) and 5-fluorouracil (5-FU) to the scleral flap at the time of surgery. The use of these agents has increased the success rate of trabeculectomy but also has increased the prevalence of hypotony. Hypotony is a problem that develops when aqueous flows out of the eye too fast. The eye pressure drops too low (usually less than 6.0 mmHg); the structure of the eye collapses and vision decreases.
Trabeculectomy creates a pathway for aqueous fluid to escape to the surface of the eye. At the same time, it creates a pathway for bacteria that normally live on the surface of the eye and eyelids to get into the eye. If this happens, an internal eye infection can occur called endophthalmitis. Endophthalmitis often leads to permanent and profound visual loss. Endophthalmitis can occur anytime after trabeculectomy. The risk increases with the thin blobs that develop after MMC and 5-FU. Another factor that contributes to infection is the placement of a bleb. Eyes that have trabeculectomy performed inferiorly have about five times the risk of eye infection than eyes that have a superior bleb. Therefore, initial trabeculectomy is performed superiorly under the eyelid, in either the nasal or temporal quadrant.
In addition to scarring, hypotony and infection, there are other complications of trabeculectomy. The bleb can tear and lead to profound hypotony. The bleb can be irritating and can disrupt the normal tear film, leading to blurred vision. Patients with blebs generally cannot wear contact lenses. All of the complications from trabeculectomy stem from the fact that fluid is being diverted from inside the eye to the external surface of the eye.
When trabeculectomy doesn't successfully lower the eye pressure, the next surgical step often is an aqueous shunt device. An aqueous diversion device of the prior art is a silicone tube that is attached at one end to a plastic (polypropylene or other synthetic) plate. With an aqueous shunt device, an incision is made in the conjunctiva, exposing the sclera. The plastic plate is sewn to the surface of the eye posteriorly, usually over the equator. A full thickness hole is made into the eye at the limbus, usually with a needle. The tube is inserted into the eye through this hole. The external portion of the tube is covered with either donor sclera or pericardium. The conjunctiva is replaced and the incision is closed tightly.
With prior art aqueous diversion devices, aqueous drains out of the eye through the silicone tube to the surface of the eye. Deeper orbital tissues then absorb the fluid. The outside end of the tube is protected from fibroblasts and scarring by the plastic plate. Many complications are associated with aqueous shunt devices. A thickened wall of scar tissue that develops around the plastic plate offers some resistance to outflow and in many eyes limits the reduction in eye pressure. In some eyes, hypotony develops because the flow through the tube is not restricted. Many physicians tie an absorbable suture around the tube and wait for the suture to dissolve post-operatively at which time enough scar tissue has hopefully formed around the plate. Some devices contain a pressure-sensitive valve within the tube, although these valves may not function properly. The surgery involves operating in the posterior orbit and many patients develop an eye muscle imbalance and double vision post-operatively. With prior art aqueous shunt devices, a pathway is created for bacteria to get into the eye and endophthalmitis can potentially occur.
The prior art includes a number of such aqueous shunt devices, such as U.S. Pat. No. 4,936,825 (providing a tubular shunt from the anterior chamber to the corneal surface for the treatment of glaucoma), U.S. Pat. No. 5,127,901 (directed to a transscleral shunt from the anterior chamber to the subconjunctival space), U.S. Pat. No. 5,180,362 (teaching a helical steel implant that is placed to provide drainage from the anterior chamber to the subconjunctival space), and U.S. Pat. No. 5,433,701 (generally teaching shunting from the anterior chamber to the scleral or conjunctival spaces).
In addition to the prior art aqueous shunt devices described above, other prior art devices for glaucoma surgery have used setons, or other porous, wick-like components to divert and convey excess aqueous from the anterior chamber to the exterior ocular surface. Examples include U.S. Pat. Nos. 4,634,418 and 4,787,885 (teaching the surgical treatment of glaucoma using an implant that consists of a triangular seton (wick)), and U.S. Pat. No. 4,946,436, (teaching the use of a porous device to shunt anterior chamber to subscleral space). These patents do not teach placement in Schlemm's canal.
Some prior art references for glaucoma management have been directed at Schlemm's canal, but these have not involved the placement of long-term, indwelling shunts. U.S. Pat. No. 5,360,399 teaches the temporary placement of a plastic or steel tube with preformed curvature in Schlemm's canal with injection of a viscous material through the tube to hydraulically expand and hydrodissect the trabecular meshwork. The tube is removed from the canal following injection. Because the tube is directed outwardly from the eye for injection access, the intersection of the outflow element with the preformed curved element within Schlemm's canal is at about a 90 degree angle relative to the plane of the curvature, and 180 degrees away from the anterior chamber. Therefore, at no time does any portion of the '399 device communicate with the anterior chamber. Furthermore, relative to that portion within Schlemm's canal, this tube has a larger diameter injection cuff element, which serves as an adapter for irrigation. Therefore, this device is not adapted for shunting aqueous between the anterior chamber and Schlemm's canal.
Most of the problems that have developed with current glaucoma treatment devices and procedures have occurred because aqueous fluid is drained from inside of the eye to the surface of the eye. A need exists, then, for a more physiologic system to enhance the drainage of aqueous fluid from the anterior chamber into Schlemm's canal. In the vast majority of glaucoma patients, the resistance problem lies between Schlemm's canal and the anterior chamber. The canal itself, the collecting channels and the episcleral venous system all are intact. Enhancing aqueous flow directly into Schlemm's canal would minimize the scarring that usually occurs with external filtration procedure since the internal angle region is populated with a single line of nonproliferating trabecular cells. Enhancing aqueous flow directly into Schlemm's canal would minimize hypotony since the canal is part of the normal outflow system and is biologically engineered to handle the normal volume of aqueous humor. Enhancing aqueous flow directly into Schlemm's canal would eliminate complications such as endophthalmitis and leaks.
The present invention is directed to a novel shunt and an associated surgical method for the treatment of glaucoma in which the shunt is placed to divert aqueous humor from the anterior chamber of the eye into Schlemm's canal. The present invention therefore facilitates the normal physiologic pathway for drainage of aqueous humor from the anterior chamber, rather than shunting to the sclera or another anatomic site as is done in most prior art shunt devices. The present invention is further directed to providing a permanent, indwelling shunt to provide increased egress of aqueous humor from the anterior chamber to Schlemm's canal for glaucoma management.
The present invention provides an aqueous humor shunt device to divert aqueous humor in the eye from the anterior chamber into Schlemm's canal, in which the shunt device comprises a distal portion having at least one terminal aspect sized and shaped to be circumferentially received within a portion of Schlemm's canal, and a proximal portion having at least one terminal aspect sized and shaped to be received within the anterior chamber of the eye, wherein the device permits fluid communication between the proximal portion in the anterior chamber to the distal portion in Schlemm's canal. Fluid communication can be facilitated by an aqueous humor directing channel in either the proximal or distal portions, as described below. Fluid communication can also be facilitated by a wicking function of a solid proximal or distal portions of the device, for example.
The present invention also provides embodiments of an inventive shunt comprising a body of biocompatible material of a size and shape adapted to be at least partially circumferentially received within a portion of Schlemm's canal to divert aqueous humor from the anterior chamber of the human eye to and within Schlemm's canal, and wherein the body facilitates the passage of aqueous humor from the anterior chamber into Schlemm's canal. This embodiment of the device of the present invention can be produced without the proximal portion of the previous embodiment extending into the anterior chamber. An aqueous humor directing channel can facilitate the passage of aqueous humor from the anterior chamber into Schlemm's canal. Fluid communication can also be facilitated by a wicking function of a solid body portion, for example.
The invention contemplates many different configurations for an aqueous humor directing channel, provided that each assists in channeling aqueous humor from the anterior chamber to Schlemm's canal, such as by providing a lumen, trough, wick or capillary action. For example, the aqueous humor directing channel can be a fully enclosed lumen, a partially enclosed lumen, or a trough-like channel that is at least partially open. The invention contemplates that a solid monofilament or braided polymer, such as proline, can be inserted into Schlemm's canal to provide a wicking function to facilitate the passage of aqueous humor from the anterior chamber to Schlemm's canal. Such a wicking extension can also be grooved or fluted along any portion of the length thereof, so as to be multi-angular or star-shaped in cross-section. The devices of the present invention can be constructed of a solid, matrix, mesh, fenestrated, or porous material, or combinations thereof.
Traditional glaucoma teaching states that Schlemm's canal in an adult is divided by septa into separate canals, rendering the complete passage of a suture impossible. Preliminary studies on adult human eye bank eyes have shown that Schlemm's canal is, indeed, patent. A suture can be passed through the entire circumference of the canal. It has not been heretofore determined that Schlemm's canal is patent throughout its circumference in normal adult individuals, as opposed to being divided by septae into multiple dead end canals. The invention utilizes this knowledge to access Schlemm's canal and to create and maintain the natural physiologic egress of aqueous humor from the anterior chamber to Schlemm's canal and to the collecting channels.
The present invention also provides methods of use of the shunt devices. One embodiment of the present invention is directed to a surgical method to divert aqueous humor from the anterior chamber of the eye into Schlemm's canal with a device that is implanted to extend from within the anterior chamber to Schlemm's canal. The portion of the device extending into Schlemm's canal can be fashioned from a flexible material capable of being received within a portion of the radius, curvature, and diameter of Schlemm's canal. All or parts of the device may be solid, porous, tubular, trough-like, fenestrated, or pre-curved.
One embodiment of the present invention is illustrated in
An alternate embodiment of the present invention is shown in
An alternate embodiment of the present invention is shown in
Other examples of embodiments of the present invention are shown in
As the inventive device is an implant, it can be fabricated from a material that will be compatible with the tissues and fluids with which it is in contact. It is preferable that the device not be absorbed, corroded, or otherwise structurally compromised during its in situ tenure. Moreover, it is equally important that the eye tissues and the aqueous remain non-detrimentally affected by the presence of the implanted device. A number of materials are available to meet the engineering and medical specifications for the shunts. In the exemplary embodiments of the present invention, the shunt device 100 is constructed of a biologically inert, flexible material such as silicone or similar polymers. Alternate materials might include, but are not limited to, thin-walled Teflon, polypropylene, other polymers or plastics, metals, or some combination of these materials. The shunt device 100 may be constructed as either porous or solid in alternate embodiments. The material can contain a therapeutic agent deliverable to the adjacent tissues.
In the embodiments shown in
Because the nature of the iris 40 is such that it tends to comprise a plurality of rather flaccid fimbriae of tissue, it is desirable to avoid said fimbriae from being drawn into the lumen of an implant, thus occluding the shunt device. Therefore, the proximal portion 10 may contain a plurality of fenestrations to allow fluid ingress, arranged to prevent occlusion by the adjacent iris. Alternately, the proximal portion 10 may comprise only a proximal portion portal 18 in the form of a fenestration oriented anteriorly to provide continuous fluid egress between the anterior chamber of the eye and the directing channel of the shunt. Said fenestrations may be any functional size, and circular or non-circular in various embodiments of the present invention. In addition, a porous structural material can assist in channeling aqueous humor, while minimizing the potential for intake of fimbriae.
Furthermore, the proximal portion 10 may be positioned sufficiently remote from the iris 40 to prevent interference therewith such as by traversing a more anterior aspect of the trabecular meshwork into the peripheral corneal tissue. In yet another possible embodiment, as shown in
The device 100 may contain one or more unidirectional valves to prevent backflow into the anterior chamber from Schlemm's canal. The internal lumen for an enclosed portion of the device or the internal channel defined by the edges of an open portion of the device communicates directly with the inner lumen or channel of the distal portion at the proximal portion portal 20.
The distal portion 25 may have a preformed curve to approximate the 6.0 mm radius of Schlemm's canal in a human eye. Such a pre-formed curvature is not required when flexible material is used to construct the shunt device 100. The distal portion 25 may be of sufficient length to extend from the junction with the proximal portion 10 through any length of the entire circumference of Schlemm's canal. Embodiments having a distal portion 25 that extends in either direction within Schlemm's canal can extend in each direction about 1.0 mm to 20 mm, or about 3.0 mm, to permit circumferential placement through Schlemm's canal. The diameter or width of the distal portion 25 can be sized to yield an outer diameter of between about 0.1 and 0.5 mm, or about 0.3 mm, for a tubular or curved shunt, or a comparable maximal width for a shunt with a multiangular configuration. The distal portion 25 may contain a plurality of fenestrations to allow fluid egress, arranged to prevent occlusion by the adjacent walls of Schlemm's canal. In other embodiments, the distal portion is a non-luminal, non-trough-like wicking extension that provides an aqueous humor directing channel along the length thereof.
In the exemplary embodiments of the present invention, the shunt device may be either bi-directional, with the distal portion of the implant intersecting with the proximal portion in a “T-shaped” junction as shown in
The surgical anatomy relevant to the present invention is illustrated in
In yet another embodiment of the present invention not shown, the shunt device 100 is configured with one distal portion 25 which is tubular to provide a shunting functionality and a plurality of proximal portions 10 which provide an anchoring function to stabilize the overall implant device, in addition to providing fluid communication from the anterior chamber to Schlemm's Canal.
The surgical procedure necessary to insert the device requires an approach through a conjunctival flap. A partial thickness scleral flap is then created and dissected half-thickness into clear cornea. The posterior aspect of Schlemm's canal is identified and the canal is entered posteriorly. The anterior chamber may be deepened with injection of a viscoelastic and a miotic agent. The proximal portion of the shunt is then inserted through the inner wall of Schlemm's canal and trabecular meshwork into the anterior chamber within the angle between the iris and the cornea. In some cases, as incision may be needed from Schlemm's canal through the trabecular meshwork into the anterior chamber to facilitate passage of the proximal portion therethrough. One arm of the distal portion of the shunt device is grasped and threaded into Schlemm's canal. In a similar fashion, the other arm of the distal portion of the shunt device (when present) is inserted into Schlemm's canal in the opposing direction from the first. The scleral flap and conjunctival wound are closed in a conventional manner.
While the above-described embodiments are exemplary, the invention contemplates a wide variety of shapes and configurations of the shunt to provide fluid communication between the anterior chamber and Schlemm's canal. The above-described embodiments are therefore not intended to be limiting to the scope of the claims and equivalents thereof.
This application is a continuation of U.S. patent application Ser. No. 10/987,114, filed Nov. 12, 2004, which is a continuation of U.S. patent application Ser. No. 10/445,740, filed May 27, 2003, now U.S. Pat. No. 6,827,700, issued on Dec. 7, 2004, which is a continuation of U.S. patent application Ser. No. 10/242,385, filed Sep. 12, 2002, now U.S. Pat. No. 6,626,858, issued on Sep. 30, 2003, which is a continuation of U.S. patent Ser. No. 09/558,505, filed Apr. 26, 2000, now U.S. Pat. No. 6,450,984, issued on Sep. 17, 2002, which claims the benefit of U.S. Provisional Application No. 60/131,030, filed Apr. 26, 1999.
The U.S. Government has reserved a nonexclusive, irrevocable, royalty-free license in the invention with power to grant licenses for all governmental purposes.
Number | Name | Date | Kind |
---|---|---|---|
2127903 | Bowen | Aug 1938 | A |
3159161 | Ness | Dec 1964 | A |
3788327 | Donowitz et al. | Jan 1974 | A |
3827700 | Kaller | Aug 1974 | A |
4037604 | Newkirk | Jul 1977 | A |
4113088 | Binkhorst | Sep 1978 | A |
4168697 | Cantekin | Sep 1979 | A |
4175563 | Arenberg et al. | Nov 1979 | A |
4402681 | Haas et al. | Sep 1983 | A |
4428746 | Mendez | Jan 1984 | A |
4457757 | Molteno | Jul 1984 | A |
4501274 | Skjaerpe | Feb 1985 | A |
4521210 | Wong | Jun 1985 | A |
4554918 | White | Nov 1985 | A |
4583224 | Ishii et al. | Apr 1986 | A |
4604087 | Joseph | Aug 1986 | A |
4632842 | Karwoski et al. | Dec 1986 | A |
4634418 | Binder | Jan 1987 | A |
4718907 | Karwoski et al. | Jan 1988 | A |
4722724 | Schocket | Feb 1988 | A |
4733665 | Palmaz | Mar 1988 | A |
4750901 | Molteno | Jun 1988 | A |
4787885 | Binder | Nov 1988 | A |
4804382 | Turina et al. | Feb 1989 | A |
4820626 | Williams et al. | Apr 1989 | A |
4846172 | Berlin | Jul 1989 | A |
4846793 | Leonard et al. | Jul 1989 | A |
4853224 | Wong | Aug 1989 | A |
4863457 | Lee | Sep 1989 | A |
4883864 | Scholz | Nov 1989 | A |
4886488 | White | Dec 1989 | A |
4900300 | Lee | Feb 1990 | A |
4936825 | Ungerleider | Jun 1990 | A |
4946436 | Smith | Aug 1990 | A |
4968296 | Ritch et al. | Nov 1990 | A |
4997652 | Wong | Mar 1991 | A |
5005577 | Frenkel | Apr 1991 | A |
5041081 | Odrich | Aug 1991 | A |
5073163 | Lippman | Dec 1991 | A |
5092837 | Ritch et al. | Mar 1992 | A |
5095887 | Leon et al. | Mar 1992 | A |
5127901 | Odrich | Jul 1992 | A |
5129895 | Vassiliadis et al. | Jul 1992 | A |
5164188 | Wong | Nov 1992 | A |
5171213 | Price, Jr. | Dec 1992 | A |
5178604 | Baerveldt et al. | Jan 1993 | A |
5180362 | Worst | Jan 1993 | A |
5207685 | Cinberg et al. | May 1993 | A |
5246451 | Trescony et al. | Sep 1993 | A |
5290295 | Querals et al. | Mar 1994 | A |
5300020 | L'Esperance, Jr. | Apr 1994 | A |
5318513 | Leib et al. | Jun 1994 | A |
5334137 | Freeman | Aug 1994 | A |
5338291 | Speckman et al. | Aug 1994 | A |
5346464 | Camras | Sep 1994 | A |
5360399 | Stegmann | Nov 1994 | A |
5370607 | Memmen | Dec 1994 | A |
5370641 | O'Donnell, Jr. | Dec 1994 | A |
5372577 | Ungerleider | Dec 1994 | A |
5397300 | Baerveldt et al. | Mar 1995 | A |
5433701 | Rubinstein | Jul 1995 | A |
5443505 | Wong et al. | Aug 1995 | A |
5454796 | Krupin | Oct 1995 | A |
5472440 | Beckman | Dec 1995 | A |
5476445 | Baerveldt et al. | Dec 1995 | A |
5486165 | Stegmann | Jan 1996 | A |
5516522 | Peyman et al. | May 1996 | A |
5520631 | Nordquist et al. | May 1996 | A |
5557453 | Schalz et al. | Sep 1996 | A |
5558629 | Baerveldt et al. | Sep 1996 | A |
5558630 | Fisher | Sep 1996 | A |
5558637 | Allonen et al. | Sep 1996 | A |
5562641 | Flomenblit et al. | Oct 1996 | A |
RE35390 | Smith | Dec 1996 | E |
5601094 | Reiss | Feb 1997 | A |
5601549 | Miyagi | Feb 1997 | A |
5626558 | Suson | May 1997 | A |
5626559 | Solomon | May 1997 | A |
5626588 | Sauer et al. | May 1997 | A |
5639278 | Dereume et al. | Jun 1997 | A |
5651783 | Reynard | Jul 1997 | A |
5665114 | Weadock et al. | Sep 1997 | A |
5670161 | Healy et al. | Sep 1997 | A |
5676679 | Simon et al. | Oct 1997 | A |
5681275 | Ahmed | Oct 1997 | A |
5681323 | Arick | Oct 1997 | A |
5702414 | Richter et al. | Dec 1997 | A |
5702419 | Berry et al. | Dec 1997 | A |
5704907 | Nordquist et al. | Jan 1998 | A |
5713844 | Peyman | Feb 1998 | A |
5723005 | Herrick | Mar 1998 | A |
5741333 | Frid | Apr 1998 | A |
5743868 | Brown et al. | Apr 1998 | A |
5752928 | De Roulhac et al. | May 1998 | A |
5766242 | Wong et al. | Jun 1998 | A |
5766243 | Christensen et al. | Jun 1998 | A |
5785674 | Mateen | Jul 1998 | A |
5807302 | Wandel | Sep 1998 | A |
5810870 | Myers et al. | Sep 1998 | A |
5824072 | Wong | Oct 1998 | A |
5830139 | Abreu | Nov 1998 | A |
5830171 | Wallace | Nov 1998 | A |
5833694 | Poncet | Nov 1998 | A |
5836939 | Negus et al. | Nov 1998 | A |
5840041 | Petter et al. | Nov 1998 | A |
5865831 | Cozean et al. | Feb 1999 | A |
5868697 | Richter et al. | Feb 1999 | A |
5879319 | Pynson et al. | Mar 1999 | A |
5882327 | Jacob | Mar 1999 | A |
5886822 | Spitzer | Mar 1999 | A |
5893837 | Eagles et al. | Apr 1999 | A |
5908449 | Bruchman et al. | Jun 1999 | A |
5913852 | Magram | Jun 1999 | A |
5932299 | Katoot | Aug 1999 | A |
5968058 | Richter et al. | Oct 1999 | A |
5980928 | Terry | Nov 1999 | A |
5981598 | Tatton | Nov 1999 | A |
6004302 | Brierley | Dec 1999 | A |
6007510 | Nigam | Dec 1999 | A |
6007511 | Prywes | Dec 1999 | A |
6033434 | Borghi | Mar 2000 | A |
6045557 | White et al. | Apr 2000 | A |
6050970 | Baerveldt | Apr 2000 | A |
6050999 | Paraschac et al. | Apr 2000 | A |
6059772 | Hsia et al. | May 2000 | A |
6059812 | Clerc et al. | May 2000 | A |
6063116 | Kelleher | May 2000 | A |
6063396 | Kelleher | May 2000 | A |
6071286 | Mawad | Jun 2000 | A |
6077299 | Adelberg et al. | Jun 2000 | A |
6102045 | Nordquist et al. | Aug 2000 | A |
6123668 | Abreu | Sep 2000 | A |
6142990 | Burk | Nov 2000 | A |
6165210 | Lau et al. | Dec 2000 | A |
6168575 | Soltanpour | Jan 2001 | B1 |
6174305 | Mikus et al. | Jan 2001 | B1 |
6186974 | Allan et al. | Feb 2001 | B1 |
6187016 | Hedges et al. | Feb 2001 | B1 |
6193656 | Jeffries et al. | Feb 2001 | B1 |
6197056 | Schachar | Mar 2001 | B1 |
6203513 | Yaron et al. | Mar 2001 | B1 |
6217895 | Guo et al. | Apr 2001 | B1 |
6228873 | Brandt et al. | May 2001 | B1 |
6231597 | Deem et al. | May 2001 | B1 |
6241721 | Cozean et al. | Jun 2001 | B1 |
6251090 | Avery et al. | Jun 2001 | B1 |
6254612 | Hieshima | Jul 2001 | B1 |
6261256 | Ahmed | Jul 2001 | B1 |
6266182 | Morita | Jul 2001 | B1 |
6268398 | Ghosh et al. | Jul 2001 | B1 |
6287256 | Park et al. | Sep 2001 | B1 |
6287313 | Sasso | Sep 2001 | B1 |
6299895 | Hammang et al. | Oct 2001 | B1 |
6331313 | Wong et al. | Dec 2001 | B1 |
6342058 | Portney | Jan 2002 | B1 |
6348042 | Warren, Jr. | Feb 2002 | B1 |
6361519 | Knudson et al. | Mar 2002 | B1 |
6375642 | Grieshaber et al. | Apr 2002 | B1 |
6413540 | Yaacobi | Jul 2002 | B1 |
6416777 | Yaacobi | Jul 2002 | B1 |
6428501 | Reynard | Aug 2002 | B1 |
6436427 | Hammang et al. | Aug 2002 | B1 |
6450937 | Mercereau et al. | Sep 2002 | B1 |
6450984 | Lynch et al. | Sep 2002 | B1 |
6464724 | Lynch et al. | Oct 2002 | B1 |
6471666 | Odrich | Oct 2002 | B1 |
6524275 | Lynch et al. | Feb 2003 | B1 |
6530896 | Elliott | Mar 2003 | B1 |
6533768 | Hill | Mar 2003 | B1 |
6544249 | Yu et al. | Apr 2003 | B1 |
6548078 | Guo et al. | Apr 2003 | B2 |
6579235 | Abita et al. | Jun 2003 | B1 |
6585680 | Bugge | Jul 2003 | B2 |
6595945 | Brown | Jul 2003 | B2 |
6622473 | Becquerelle et al. | Sep 2003 | B2 |
6626858 | Lynch et al. | Sep 2003 | B2 |
6629981 | Bui et al. | Oct 2003 | B2 |
6638239 | Bergheim et al. | Oct 2003 | B1 |
6666841 | Gharib et al. | Dec 2003 | B2 |
6699211 | Savage | Mar 2004 | B2 |
D490152 | Myall et al. | May 2004 | S |
6736791 | Tu et al. | May 2004 | B1 |
6780165 | Kadziauskas et al. | Aug 2004 | B2 |
6783544 | Lynch et al. | Aug 2004 | B2 |
6827699 | Lynch et al. | Dec 2004 | B2 |
6827700 | Lynch et al. | Dec 2004 | B2 |
6955656 | Bergheim et al. | Oct 2005 | B2 |
7033603 | Nelson et al. | Apr 2006 | B2 |
7094225 | Tu et al. | Aug 2006 | B2 |
7135009 | Tu et al. | Nov 2006 | B2 |
7163543 | Smedley et al. | Jan 2007 | B2 |
7186232 | Smedley et al. | Mar 2007 | B1 |
7192412 | Zhou et al. | Mar 2007 | B1 |
7220238 | Lynch et al. | May 2007 | B2 |
7273475 | Tu et al. | Sep 2007 | B2 |
7297130 | Bergheim et al. | Nov 2007 | B2 |
7331984 | Tu et al. | Feb 2008 | B2 |
7431710 | Tu et al. | Oct 2008 | B2 |
7488303 | Haffner et al. | Feb 2009 | B1 |
7563241 | Tu et al. | Jul 2009 | B2 |
7678065 | Haffner et al. | Mar 2010 | B2 |
7708711 | Tu et al. | May 2010 | B2 |
7850637 | Lynch et al. | Dec 2010 | B2 |
7857782 | Tu et al. | Dec 2010 | B2 |
7867186 | Haffner et al. | Jan 2011 | B2 |
7867205 | Bergheim et al. | Jan 2011 | B2 |
7879001 | Haffner et al. | Feb 2011 | B2 |
7879079 | Tu et al. | Feb 2011 | B2 |
7951155 | Smedley et al. | May 2011 | B2 |
8007459 | Haffner et al. | Aug 2011 | B2 |
8062244 | Tu et al. | Nov 2011 | B2 |
8075511 | Tu et al. | Dec 2011 | B2 |
8152752 | Lynch et al. | Apr 2012 | B2 |
20020013546 | Grieshaber et al. | Jan 2002 | A1 |
20020013572 | Berlin | Jan 2002 | A1 |
20020026200 | Savage | Feb 2002 | A1 |
20020072673 | Yamamoto et al. | Jun 2002 | A1 |
20020082591 | Haefliger | Jun 2002 | A1 |
20020099434 | Buscemi et al. | Jul 2002 | A1 |
20020133168 | Smedley et al. | Sep 2002 | A1 |
20020143284 | Tu et al. | Oct 2002 | A1 |
20020165478 | Gharib et al. | Nov 2002 | A1 |
20020169130 | Tu et al. | Nov 2002 | A1 |
20020188308 | Tu et al. | Dec 2002 | A1 |
20030055372 | Lynch et al. | Mar 2003 | A1 |
20030060752 | Bergheim et al. | Mar 2003 | A1 |
20030088260 | Smedley et al. | May 2003 | A1 |
20030097151 | Smedley et al. | May 2003 | A1 |
20030181848 | Bergheim et al. | Sep 2003 | A1 |
20030187384 | Bergheim et al. | Oct 2003 | A1 |
20030187385 | Bergheim et al. | Oct 2003 | A1 |
20030229303 | Haffner et al. | Dec 2003 | A1 |
20030236483 | Ren | Dec 2003 | A1 |
20030236484 | Lynch et al. | Dec 2003 | A1 |
20040024345 | Gharib et al. | Feb 2004 | A1 |
20040050392 | Tu et al. | Mar 2004 | A1 |
20040102729 | Haffner et al. | May 2004 | A1 |
20040111050 | Smedley et al. | Jun 2004 | A1 |
20040127843 | Tu et al. | Jul 2004 | A1 |
20040147870 | Burns et al. | Jul 2004 | A1 |
20040154946 | Solovay et al. | Aug 2004 | A1 |
20040254520 | Porteous et al. | Dec 2004 | A1 |
20050038334 | Lynch et al. | Feb 2005 | A1 |
20050049578 | Tu et al. | Mar 2005 | A1 |
20050090807 | Lynch et al. | Apr 2005 | A1 |
20050119601 | Lynch et al. | Jun 2005 | A9 |
20050119737 | Bene et al. | Jun 2005 | A1 |
20050125003 | Pinchuk et al. | Jun 2005 | A1 |
20050192527 | Gharib et al. | Sep 2005 | A1 |
20050250788 | Tu et al. | Nov 2005 | A1 |
20050271704 | Tu et al. | Dec 2005 | A1 |
20050277864 | Haffner et al. | Dec 2005 | A1 |
20060032507 | Tu | Feb 2006 | A1 |
20060173397 | Tu et al. | Aug 2006 | A1 |
20060200113 | Haffner et al. | Sep 2006 | A1 |
20070088432 | Solovay et al. | Apr 2007 | A1 |
20070293807 | Lynch et al. | Dec 2007 | A1 |
20080108934 | Berlin | May 2008 | A1 |
20090138081 | Bergheim et al. | May 2009 | A1 |
20100010414 | Bergheim et al. | Jan 2010 | A1 |
Number | Date | Country |
---|---|---|
200072059 | Dec 2000 | AU |
2244646 | Aug 1998 | CA |
92111244 | Jul 1993 | CH |
198 40 047 | Mar 2000 | DE |
0 858 788 | Aug 1998 | EP |
0881 055 | Dec 1998 | EP |
0 898 947 | Mar 1999 | EP |
1 114 627 | Nov 2001 | EP |
2710269 | Mar 1995 | FR |
2 721 499 | Dec 1995 | FR |
2 296 663 | Jul 1996 | GB |
11-123205 | May 1999 | JP |
WO 8900869 | Feb 1989 | WO |
WO 9118568 | Dec 1991 | WO |
WO 9200112 | Jan 1992 | WO |
WO 9219294 | Nov 1992 | WO |
WO 9413234 | Jun 1994 | WO |
WO 9421205 | Sep 1994 | WO |
WO 9508310 | Mar 1995 | WO |
WO 9636377 | Nov 1996 | WO |
WO 9823237 | Jun 1998 | WO |
WO 9830181 | Jul 1998 | WO |
WO 9835639 | Aug 1998 | WO |
WO 9926567 | Jun 1999 | WO |
WO 9930641 | Jun 1999 | WO |
WO 9938470 | Aug 1999 | WO |
WO 0013627 | Mar 2000 | WO |
WO 0064389 | Nov 2000 | WO |
WO 0064390 | Nov 2000 | WO |
WO 0064391 | Nov 2000 | WO |
WO 0064393 | Nov 2000 | WO |
WO 0072788 | Dec 2000 | WO |
WO 0141685 | Jun 2001 | WO |
WO 0150943 | Jul 2001 | WO |
WO 0178631 | Oct 2001 | WO |
WO 0178656 | Oct 2001 | WO |
WO 0197727 | Dec 2001 | WO |
WO 0236052 | May 2002 | WO |
WO 02056758 | Jul 2002 | WO |
WO 02074052 | Sep 2002 | WO |
WO 02080811 | Oct 2002 | WO |
WO 03015659 | Feb 2003 | WO |
WO 03073968 | Sep 2003 | WO |
Entry |
---|
Patent Family List for U.S. Appl. No. 12/437,383, pdf document of file date Jul. 18, 2011. |
Beck and Lynch, “360° Trabeculotomy for Primary Glaucoma,” Arch. Ophthalmol. 113 (Sep. 1995), pp. 1200-1202. |
Buskirk et al., “Lens Depression and Aqueous Outflow in Enucleated Primate Eyes,” American Journal of Ophthalmology, vol. 76, No. 5, Nov 1973, pp. 632-640. |
Buskirk et al., “Trabeculotomy in the immature, enucleated human eye,” Invest. Ophthalmol. Visual Sci., vol. 6, No. 1, Jan. 1977, pp. 63-66. |
DeMailly, P., et al., “Non-Penetrating Deep Sclerectomy Combined With a Collagen Implant in Primary Open-Angle Glaucoma. Medium-Term Retrospective Results”, J. Fr. Ophthalmol., vol. 19, No. 11, 1996, pp. 659-666. (abstract only). |
Fine et al., “A Clinicopathologic Study of Four Cases of Primary Open-Angle Glaucoma Compared to Normal Eyes”, American Journal of Ophthalmology, vol. 91, No. 1, 1981, pp. 88-105. |
Gharagozloo et al., “Unilateral Exfoliation Syndrome Without Glaucoma—A Comparison of Aqueous Dynamica Between Affected and Normal Eyes”, Glaucoma Paper Presentation. (abstract only—not dated). |
Hamard, P., et al., “Deep Nonpenetrating Sclerectomy and Open Angle Glaucoma. Intermediate Results From Thbe First Operated Patients”, J. Fr. Ophthalmol., vol. 22 (j), Feb. 1999, pp. 25-31, (abstract only). |
Improving The Flow: A Survey of Available Implants, EW Practice Managment, Oct. 11, 1999, website “http://www.eyeworld.org/tooltime/999inserts.asp”. |
Johnson, M.C. and R. D. Kamm, The Role of Schlemm's Canal in Aqueous Outflow from the Human Eye, Investigative Ophthalmology & Visual Science, Mar. 1983, vol. 24, pp. 321-325. |
Karlen, M.E., et al., “Deep Sclerectomy With Collagen Implant: Medium Term Results”, Br. J. Ophthalmol. vol. 83, No. 1, Jan. 1999, pp. 6-11, (abstract only). |
Mermoud, A., et al., “Comparison of Deep Sclerectomy With Collagen Implant and Trabeculectomy in Open-Angle Glaucoma”, J. Cataracat Refract. Surg., vol. 25, No. 3, Mar. 1999, pp. 323-331, (abstract only). |
McMenamin, et al., “Age-Related Changes in the Human Outflow Apparatus”, Ophthalmology, vol. 93, No. 2., Feb. 1986, pp. 194-209. |
Moses, Robert A. et al., “Blood Reflux in Schlemm's Canal”, Arch Ophthamol., vol. 97, Jul. 1979, pp. 1307-1310. |
Moses, Robert A. M.D., Circumferential Flow in Schlemm's Canal, American Journal of Ophthalmology, Sep. 1979, vol. 88, No. 3, Part II, pp. 585-591. |
Robinson, et al., “Superior Cervical Ganglionectomy: Effects on Aqueous Human Flow in the Cynomolgus Monkey”, Glaucoma Paper Presentation, (abstract only—not dated). |
Samalonis, Lisa B., “New Horizons in the Surgical Treatment of Glaucoma”, Ew Glaucoma, Oct. 11, 1999, website “http://www.eyeworld.org/sep99/999p62.asp”. |
Shields, M. Bruce, Textbook of Glaucoma, Fourth Ed., Williams & Wilkins Publishers, 1998, pp. 5-31. |
Tripathi et al. “Functional Anatomy of the Anterior Chamber Angle”, Biomedical Foundations of Ophthalmology, 1(10): 1-74, Ed. Thomas Dune and Edward Jaeger, Revised Ed. 1983, Harper & Row. |
U.S. Clinical Wick Trials, Oct. 11, 1999, website http://www.cornea.org/us.htm. |
Welsh, N. H., et al., “The ‘Deroofing’ of Schlemm's Canal in Patients With Open-Angle Glaucoma Through Placement of a Collagen Drainage Device”, Ophthalmic Surg. Lasers, vol. 29, No. 3, Mar. 1998, pp. 216-226, (abstract only). |
Wilson, Ellen D., “Implants Offer Choices for Glaucoma Surgeons”, EW Glaucoma, Oct. 11, 1999, website “http://www.eyeorld.org/sep99/999p60.asp”. |
Anselm Kampik and Franz Grehn, Nutzen and Risiken augenärztlicher Therapie, Hauptreferate der XXXIII. Essener Fortbildung für Augenärzte, Dec. 1998. (English translated version enclosed Benefits and Risks of Ophthalmological Therapy.). |
Phillip C. Jacobi, MD, Thomas S. Dietlein, MD, and Gunter K. Krieglstein, MD., Goniocurettage for Removing Trabecular Meshwork: Clinical Results of a New Surgical Technique in Advanced Cronic Open-Angle Glaucoma, American Journal of Ophthalmology, May 1999, pp. 505-510. |
Philip C. Jacobi, MD, Thomas S. Dietlein, MD, and Gunter K. Krieglstein, MD., Bimanual Trabecular Aspiration in Pseudoexfoliation Glaucoma, Ophthalmology, 1998, vol. 105, No. 5, May 1998, pp. 886-894. |
Phillip C. Jacobi, MD, Thomas S. Dietlein, MD, and Gunter K. Krieglstein, MD., Microendoscopic Trabecular Surgery in Glaucoma Management, Ophthalmology, 1999, vol. 106, No. 3, pp. 538-544. |
Arthur L. Schwartz, MD, and Douglas R. Anderson, MD, Trabecular Surgery, Arch Ophthalmol, vol. 92, Aug. 1974, pp. 134-138. |
R.A. Hill, Q. Ren, D.D. Nguyen, L-H Liaw, and M.W. Berns, Free-Electron Laser (FEL) Ablation of Ocular Tissues, Lasesr Med Sci 1998, pp. 13:219-226. |
Maurice H. Luntz, MD, and D.G. Livingston, B.SC., Trabeculotomy AB Externo and Trabeculectomy in Congenital and Adult-Onset Glaucoma, American Journal of Ophthalmology, Feb. 1977, vol. 83, No. 2, pp. 174-179. |
W.M. Grant, MD, Further Studies on Facility of Flow Through the Trabecular Meshwork, A.M.A. Archives of Ophthalmololgy, Oct. 1958, vol. 60, pp. 523-533. |
Richard A. Hill, MD, George Baerveldt, MD, Serdar A. Ozler, MD, Michael Pickford, BA, Glen A. Profeta, BS, and Michael W. Berns,PhD, Laser Trabecular Ablation (LTA), Laser in Surgery and Medicine, 1991, vol. 11, pp. 341-346. |
Detlev Spiegel, MD, Karin Kobuch, MD, Richard A. Hill, MD, Ronald L. Gross, MD, Schlemm's Canal Implant: A New Method to Lower Intraocular Pressure in Patients With POAG, Ophthalmic Surgery and Lasers, Jun., 1999, vol. 30, No. 6, pp. 492-494. |
Hans Hoerauf, Christopher Wirbelauer, Christian Scholz, Ralf Engelhardt, Peter Koch, Horst Laqua, and Reginald Birngruber, Slit-Lamp-Adapted Optical Coherence Tomography of the Anteriuor Segment, Graefe's Arch Clin. Exp. Ophthalmol, May, 1999, vol. 238, pp. 8-18. |
Sumita Radhakrishnan, Andrew M. Rollins, Jonathan E. Roth, S. Yazddanfar, Volker Westphal, David Bardenstein, and Joseph Izatt, Real-Time Optical Coherence Tomography of the Anterior Segment at 1310 nm, Arch Ophthalmology, Aug. 2001, vol. 119, pp. 1179-1185. |
I. Grierson, R.C. Howes, and Q. Wang, Age-related Changes in the Canal of Schlemm, Exp. Eye Res., 1984, vol. 39, pp. 505-512. |
Luanna K. Putney, Cecile Rose T. Vibat, and Martha E. O'Donnell, Intracellular C1 Regulates Na-K-C1 Cotransport Activity in Human Trabecular Meshwork Cells, 1999 American Physiological Society, Sep. 1999, pp. C373 through C383. |
William Tatton, Ruth M.E. Chalmers-Redman, Ajay Sud, Steven M. Podos, and Thomas Mittag, Maintaining Mitochondrial Membrane Impermeability: An Opportunity for New Therapy in Glaucoma, Survey of Ophthalmology, vol. 45, Supplement 3, May 2001, pp. S277 through S283. |
Robert W. Nickells, Apoptosis of Retinal Ganglion Cells in Glaucoma: An Update of the Molecular Pathways Involved in Cell Death, Survey of Ophthalmology, vol. 43, Supplement 1, Jun. 1999, pp. S-151 through S-161. |
Yasuhiro Matsumoto and Douglas H. Johnson, Trabecular Meshwork Phagocytosis in Graucomatous Eyes, Ophthalmologica 1977, vol. 211, pp. 147-152. |
M. Bruce Shields, MD, A Study Guide for Glaucoma: Aqueous Humor Dynamics, Copyright 1982, pp. 6-43. |
W.G. Tatton, Apoptotic Mechanisms in Neurodegeneration: Possible Relevance to Glaucoma, European Journal of Ophthalmology, Jan.-Mar. 1999, vol. 9, Supplement 1, pp. S22 through S29. |
L. Jay Katz, M.D., A Call for Innovative Operations for Glaucoma, Arch Ophthalmology, Mar. 2000, vol. 118, pp. 412-413. |
Cindy K. Bahler, BS, Gegrory T. Smedley, PhD, Jianbo Zhou, PhD, Douglas H. Johnson, MD., American Journal of Ophthalmology, Dec. 2004, vol. 138. |
Jianbo Zhou, PhD, Gregory T. Smedley, PhD., A Trabecular Bypass Flow Hypothesis, Feb. 2005, vol. 14 No. 1. |
U.S. Appl. No. 09/452,963, filed Dec. 2, 1999. Title: Expandable/ Retractable Stent for Venous and Valvular Annulus Use. |
Vincente L. Jocson, M.D.; Air Trabeculotomy; American Journal of Ophthalmolgy: vol. 79, No. 1, Jan.-Jun. 1975; pp. 107-111. |
Daniel A. Fletcher, Ph.D., Daniel V. Palanker, Ph.D., Philip Hule, M.D., Jason Miller, MS, Michael F. Marmor, M.D. and Mark S. Blumenkranz, M.D.; Intravascular Drug Delivery With a Pulsed Liquid Microjet; (Reprinted) Arch Ophthalmology; vol. 120, Sep. 2002, pp. 1206-1208. |
Troncoso, Manuel U., Tantalum implants for inducing hypotony, American Journal of Ophthalmology, vol. 32, No. 4, Apr. 1949, pp. 499-508 (11 pages). |
Lisa F. Rosenberg et al., Implants in Glaucoma Surgery, Chapter 88 of The Glaucomas by Robert Ritch et al., Second Edition, 1996, pp. 1783-1807. |
Kwon et al., “A Patient's Guide to Glaucoma, Section 8-B: Trabeculectomy: A Filtering Procedure,” http://www.medrounds.org/glaucoma-guide/2006/11/section-8-b-trabeculectomy-filtering.html. |
M. Bruce Shields, M.D., Textbook of Glaucoma, “Chapter 2: Aqueous Humor Dynamics,” 4th ed., pp. 5-31 (1982). |
Artur Llobet et al., Understanding Trabecular Meshwork Physiology: A Key to the Control of Intraocular Pressure?, News Physiol Sci vol. 18, pp. 205-209 (2003). |
Hoskins, et al., “Aqueous Humor Outflow”, Becker-Shaffer's Diagnosis and Therapy of the Glaucomas, 6th Edition, Chapter 4, pp. 41-66, 1989. |
Number | Date | Country | |
---|---|---|---|
20100004580 A1 | Jan 2010 | US |
Number | Date | Country | |
---|---|---|---|
60131030 | Apr 1999 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 10987114 | Nov 2004 | US |
Child | 12437383 | US | |
Parent | 10445740 | May 2003 | US |
Child | 10987114 | US | |
Parent | 10242385 | Sep 2002 | US |
Child | 10445740 | US | |
Parent | 09558505 | Apr 2000 | US |
Child | 10242385 | US |