US20070179512A1 - Surgical support structure - Google Patents

Surgical support structure Download PDF

Info

Publication number
US20070179512A1
US20070179512A1 US11/502,603 US50260306A US2007179512A1 US 20070179512 A1 US20070179512 A1 US 20070179512A1 US 50260306 A US50260306 A US 50260306A US 2007179512 A1 US2007179512 A1 US 2007179512A1
Authority
US
United States
Prior art keywords
support structure
tissue
ring
membrane
patch
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US11/502,603
Other languages
English (en)
Inventor
Timothy W. Olsen
Paul E. Loftness
Arthur G. Erdman
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of Minnesota
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to US11/502,603 priority Critical patent/US20070179512A1/en
Assigned to REGENTS OF THE UNIVERSITY OF MINNESOTA reassignment REGENTS OF THE UNIVERSITY OF MINNESOTA ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: LOFTNESS, PAUL E., OLSEN, TIMOTHY W., ERDMAN, ARTHUR G.
Publication of US20070179512A1 publication Critical patent/US20070179512A1/en
Priority to US14/499,404 priority patent/US10278808B2/en
Priority to US14/696,957 priority patent/US20150223929A1/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00727—Apparatus for retinal reattachment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00821—Methods or devices for eye surgery using laser for coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect

Definitions

  • This document pertains generally to ophthalmology, and more particularly, but not by way of limitation, to ophthalmic surgery.
  • Age-related macular degeneration is a form of degeneration that results when the delicate photoreceptors deteriorate in a highly specialized region of the central retina called the macula. AMD is the leading cause of visual impairment and blindness for many people over age 50. The cause of AMD is not fully understood, and at present, there is no cure.
  • AMD is an eye disease of the macula: a tiny area in the retina that helps produce sharp, central vision required for central visual activities such as reading, sewing, and driving. A person with AMD loses this clear, central vision and in some cases, vision loss is rapid and profound. AMD is a leading cause of severe visual impairment and blindness in the United States. According to current statistics, approximately 1.5 million citizens in the United States are affected by advanced age-related macular degeneration. This number is expected to increase to 2.95 million Americans by the year 2020, according to current government statistics.
  • AMD atrophic form
  • eAMD exudative form
  • AMD is the early stage of the disease; about 90% of the diagnosed cases of AMD are the dry form, but it is the wet form that results in most of the vision loss associated with the disease.
  • AMD is sometimes used to refer only to the advanced form of the disease and the term Age-related Maculopathy (ARM) is used to describe the early clinical findings associated with AMD.
  • ARM Age-related Maculopathy
  • Dry AMD is associated with extracellular deposits called drusen (druse is the singular form of the word but is not commonly used) that form between the retinal pigment epithelium (RPE) and Bruch's membrane. Drusen are believed to result from impaired metabolism in the RPE.
  • the RPE serves a number of roles critical to healthy vision: renewal of the photoreceptor outer segments through phagocytosis, providing a blood-retinal barrier through the tight junctions between RPE cells, and the selective transport of nutrients across Bruch's membrane to the outer retina. Dry AMD usually results in a gradual loss of central vision in the macular regions associated with the drusen and loss of the RPE.
  • Wet AMD is also associated with the drusen deposits plus new blood vessel growth or neovascularization.
  • Wet AMD results when fragile blood vessels grow from the choroid into the subretinal space, leaking blood and fluid, and leading to rapid loss of central vision.
  • the growth of new vessels under the retina is called choroidal neovascularization, or CNV.
  • Exudative AMD is a major cause of severe vision loss.
  • Wet AMD is a major cause of severe vision loss and accounts for approximately 80% of such cases.
  • Wet AMD often causes rapid decline in visual acuity.
  • the eye includes three tissue layers, or tunics as shown in the partial sagittal section of the human eye in FIG. 1 .
  • the outermost layer of the eye is fibrous tunic 10 and includes the transparent cornea (near lens 12 ) and the opaque white sclera.
  • the middle, highly vascularized layer of tissue within the eye is called uveal tract 15 .
  • the innermost tunic, or layer, of the eye is retina 20 , which is an extension of the central neural tissue of the brain.
  • Retina 20 is comprised of the multi-layered neurosensory retina 22 and a tightly spaced monolayer of hexagonal-shaped cells called the RPE 25 as shown in FIG. 2 .
  • Bruch's membrane 35 is a thin, collagenous membrane separating RPE 25 from choroid 30 as shown in FIG. 2 .
  • RPE 25 must be in close apposition to neurosensory retina 22 for normal visual function, there is only a weak attachment between these two tissue layers.
  • a graft to be harvested following retinal detachment typically includes RPE 25 lying on Bruch's membrane 35 and underlying choroid 30 .
  • the central region responsible for the greatest visual acuity is called the macula ( 40 ), a circular region approximately 5.5 mm in diameter, as shown in FIG. 1 .
  • Macula 40 contains the highest concentration of cone photoreceptor cells that are largely responsible for central, sharp vision and color vision.
  • macula 40 is shown in the middle of two temporal arcing vessels (trajectories). Macula 40 is responsible for the central 15 to 20 degrees of visual angle. At the center of macula 40 is the fovea, a 1.5 mm diameter region that contains primarily cone cells.
  • the human eye can be described as a space-variant optical system because the detector elements within retina 20 (photoreceptors 21 ) vary as a function of position. Photoreceptors 21 convert light energy entering the eye into electrochemical impulses and are often referred to as rods and cones.
  • FIG. 1 illustrates a partial sagittal view of an eye.
  • FIG. 2 illustrates a cross-sectional block of the retina, choroid and sclera.
  • FIG. 3 illustrates a sectional view of a support structure.
  • FIGS. 4A-4E illustrate exemplary support structures.
  • FIG. 5 illustrates a support structure with an insertion guide.
  • FIGS. 6A and 6B illustrate helical support structures.
  • FIG. 7 illustrates a support structure with a particular surface finish.
  • FIGS. 8A , 8 B and 8 C illustrate sectional views of exemplary support structures.
  • FIG. 9 illustrates a perspective view of a support structure.
  • FIG. 10 illustrates a tool
  • FIG. 11 illustrates a view of a support structure.
  • FIGS. 12A , 12 B and 12 C illustrate support structures in various configurations.
  • FIG. 12D illustrates a cut-away view of a support structure partially disposed in a cannula.
  • FIG. 13 illustrates a tool
  • FIGS. 14A , 14 B and 14 C illustrate exemplary support structures and corresponding coagulated regions.
  • FIGS. 15A and 15B illustrate perspective views of exemplary support structures and a portion of tissue.
  • FIGS. 16 and 17 illustrate exemplary methods of the present subject matter.
  • FIG. 18 illustrates a perspective view of a graft supported by an exemplary support structure.
  • FIGS. 19A and 19B illustrate sectional views of a support structure.
  • FIGS. 20A , 20 B, and 20 C illustrate sectional views of a support structure.
  • FIGS. 21A and 21B illustrate portions of a manipulator for controlling a support structure.
  • FIGS. 22A and 22B illustrate views of tissue repair structures.
  • FIG. 23 illustrates a support structure having deployable features.
  • FIG. 24 illustrates a multi-element support structure
  • FIGS. 25A and 25B each illustrate segmented insulation of a portion of a support structure.
  • FIG. 26 illustrates a partial sectional view of a feature affixed to a support structure.
  • the present subject matter includes methods and systems for establishing a new connection between the macula and healthy underlying tissue. Accordingly, following the procedure as described herein, the macula remains nearly in its original location, and a region of damaged, underlying RPE and choroid is replaced by surgically translocating healthy autologous tissue to support the macula.
  • the present subject matter establishes a new connection between the macula and the choroid, Bruch's membrane, and RPE complex. In one example, the macula or other layer of unhealthy tissue is removed followed by translocation of a graft.
  • the present subject matter includes translocating a patch, or tissue complex, including an underlying layer of full (or partial) thickness choroid, Bruch's membrane, and RPE.
  • the translocation procedure can be used in eyes having the wet or dry forms of AMD.
  • the periphery of the patch Prior to translocation of the patch, the periphery of the patch is coagulated using a micropulsed diode laser or other method to minimize shrinkage.
  • tissue refers to any portion of the structure illustrated in FIGS. 1 and 2 .
  • patch refers to the portion of tissue selected to support the native macular tissue. Accordingly, the patch can be an autograft (including the fellow eye), an allograft (a donor eye), a xenograft (an animal source) or a synthetic graft (generated and grown outside the eye) and describes that portion of tissue selected for translocation.
  • the term patch has meaning at a time before, during and after translocation. According to one example of the present subject matter, the patch is translocated from a first position to a second position. The patch can remain partially attached to the surrounding tissue or can be entirely separated from the surrounding tissue. Portions of this document refer to an autograft however it is understood that other sources of tissue to support the macula are also contemplated, depending upon tissue compatibility and availability.
  • the tissue and therefore the patch, can include one or more layers.
  • the patch includes tissue identified as choroid, Bruch's membrane, and RPE.
  • laser energy is used to coagulate the tissue and gain access to the suprachoroidal space for placement of a support structure.
  • the support structure can be viewed as a support frame or support structure for tissue, and in one example, is in the shape of a ring, however other configurations are also contemplated.
  • the support structure includes one ring or two rings.
  • the support structure includes one or more members each having various shapes and configurations that serve to provide support to the tissue.
  • the support structure is placed on top of the RPE, and activated by applying energy in order to coagulate and bond to the tissue.
  • pulsed laser energy from a diode laser is used to create an ablation with minimal shrinkage of surrounding tissue.
  • the donor tissue can be excised using a knife or other cutting means.
  • the laser method is effective to obtain hemostasis in the vascular choroidal tissues in order to minimize potential bleeding complications from this vascular tissue during excision.
  • Activation of the support structure with electric or radio frequency energy creates coagulation and bonding between individual segments or portions of the support structure and nearby tissue, and with little or no damage to the tissue complex supported by the support structure.
  • the tissue complex (donor graft) is disposed in the center of the ring. This tissue complex is considered an autograft since it is both harvested from and translocated to the same patient thereby avoiding immune rejection problems.
  • the laser energy is selected to either avoid ablation of the tissue or cause tissue ablation while avoiding excessive tissue shrinkage.
  • the intraocular laser has a maximum power level that is insufficient to ablate tissue.
  • Coagulation in one example, can be performed using a particular laser having a maximum power of 2 W (2,000 milliwatts) and at a distance of 3 mm from probe tip to tissue, the laser can form a region of coagulated tissue of approximately 200 microns wide as the laser probe traces a path at a relatively fixed distance from the support structure. In in vitro testing, a probe tip distance of approximately 2 mm produced good results. Larger or smaller lasers and other parameters are also contemplated.
  • a coagulated zone of tissue around the support structure is formed using an 810 nm diode laser in micropulse mode with the endoprobe held 2-3 mm from surface of tissue, a power setting of 750-2,000 milliwatts, a pulse duration of 100 microseconds, and pulse interval ranging from 500 microseconds to 1 millisecond.
  • the coagulated zone is later cut, for example with a diamond knife, to excise the graft.
  • the coagulated line can be re-traced as needed until a desired burn is achieved.
  • the laser burn line is repeatedly traced to separate the graft.
  • the surgeon is able to control the burn by altering the rate of travel (distance/time) of the laser probe over the tissue. This control allows for direct surgeon feedback-control of the burn intensity, and allows for variation in choroidal pigmentation.
  • the support structure serves as a guide to simplify retracing of the same path.
  • the present subject matter relates to a support structure that bonds to a surface of tissue.
  • the tissue includes choroid and RPE however other tissue is also contemplated.
  • One example of the present subject matter is configured to increase the strength or reinforce the patch to withstand the forces associated with manipulating the patch.
  • the present subject matter provides support for the patch.
  • One example of the present subject matter is configured to resist shrinkage and distortion of the excised tissue.
  • the RPE is susceptible to damage if folds are allowed to rub or abrade against each other.
  • the present subject matter facilitates maintenance of the orientation of the patch.
  • the patch can be viewed as having a polarity. Maintaining the polarity of the patch can be a factor in the success of the translocation of the patch.
  • the present subject matter can be effective both during and after the separation process.
  • the support structure includes a contact surface that bonds to the tissue at a target site and counters shrinkage or other distortion after the tissue is separated from the surrounding membrane.
  • the tissue at the target site after having been excised, is sometimes referred to as a graft.
  • the support structure can have a variety of configurations.
  • FIG. 3 illustrates a sectional view of an exemplary configuration for the support structure.
  • Support structure 100 which can be considered a reinforcement structure, is shown disposed on opposing surfaces of tissue 125 .
  • Support structure 100 in the example illustrated, includes ring 100 A and ring 100 B. Rings 100 A and 100 B have a circular configuration and can be endless (or contiguous), or split as illustrated in FIGS. 4A and 4B .
  • the rings of the support structure have a diameter of 5.5 mm (approximately that of the macula), however, diameters larger or smaller than that of the macula are also contemplated, including, for instance, between 1 and 8 mm.
  • rings 100 A and 100 B have different overall diameters, however, both diameters can be the same.
  • the wire gauge of the rings in one example, is 175 microns, however, sizes larger or smaller are also contemplated, including, for example a wire diameter of 0.004 inch (approximately 100 microns).
  • a split ring configuration allows insertion of a portion of support structure 100 through a guide having a length sufficient to preclude unintended penetration of an end of the support structure into the tissue.
  • a contiguous ring is formed by welding or by cutting from sheet goods.
  • the guide includes a cannula.
  • ring 100 C includes a circular support structure formed of round material. Ring 100 C has two ends 101 that are aligned at split 99 . In the example illustrated in FIG. 4A , ends 101 lie in the same plane as ring 100 C.
  • FIG. 4B illustrates exemplary ring 100 D having ends that overlap. Extension 102 protrudes beyond the circular configuration of ring 100 D and, in one example, provides a handle or tab by which the support structure can be manipulated, positioned or contacted for purposes of coupling an electrical current or other energy.
  • ring 100 C includes a shape memory material that returns to a circular configuration as illustrated in the figure, upon warming in response to body temperature.
  • Some shape memory materials have a transition temperature somewhat lower than normal body temperature and are chilled well below body temperature before placement in the body.
  • Ring 100 C is shown in a configuration where the temperature is approximately that of the body and, when at a cooler temperature, ring 100 C is in the form of a straight wire segment (not shown). As such, ring 100 C assumes a circular configuration upon ejection from a cannula using, for example, a pushrod.
  • ring 100 C is formed at the end of a long wire section and is clipped or cut upon ejection from a cannula. In one example, ring 100 C separates from the long wire at a notched or weakened segment.
  • FIGS. 4C , 4 D and 4 E illustrate alternative embodiments of a support structure with each structure having a feature to facilitate manipulation.
  • the support structure is in the form of a split ring and tab 41 extends from one end of the ring and in a direction towards the interior. A force can be applied to tab 41 , for example, to urge the support structure in a direction that increases the contact force on the membrane.
  • the support structure is in the form of an endless ring having a graduated cross section.
  • portion 42 has a narrower cross section relative to that of portion 43 .
  • the support structure is in the form of a split ring having tab 45 extending towards the interior of the ring and at a point opposite that of split 44 .
  • Tab 45 allows an operator to manipulate the support structure and adjust the contact force on the membrane.
  • the tab extends outward from the diameter of the ring.
  • FIG. 5 illustrates support structure 100 E coupled to wire 103 disposed in a lumen of guide 110 A.
  • Support structure 100 E includes a circular configured ring having overlapping ends.
  • Support structure 100 E is formed at one end of wire 103 .
  • the second end of wire 103 extends beyond guide 110 A and allows manipulation of support structure 100 E.
  • electrical energy or other energy can be applied to support structure 100 E by coupling with wire 103 .
  • support structure 100 E is separated or detached from wire 103 by cutting, breaking or other forms of device disengagement.
  • FIG. 6A illustrates a partial sectional view of exemplary support structure 100 F in contact with tissue 125 .
  • a portion of support structure 100 F is shown in section using a cut plane that lies parallel to the cut plane of tissue 125 .
  • Support structure 100 F includes a helical structure and the figure illustrates one portion of a first winding in contact with a first surface of tissue 125 and one portion of a second winding in contact with a second surface of tissue 125 .
  • FIG. 6B illustrates a perspective view of support structure 100 F without the tissue.
  • Support structure 100 F includes circular configured windings with one winding (ring) larger than another winding, however both rings can be of similar or the same size.
  • the ends of support structure 100 F overlap.
  • a helical structure includes an electrical resistance element or other structure that allows use of electric resistance heating to bond the support structure to the tissue.
  • the rings of the support structure can be attached together at a hinge rather than a winding, where both rings can be deployed simultaneously.
  • two rings of a support structure can be deployed simultaneously through a delivery system.
  • the rings can be hinged together or otherwise connected.
  • two rings can be coupled together at a pivot point thus allowing them to swing open or clamp closed around tissue.
  • the two rings are deployed together through a common sheath or insertion element, for example as shown in FIG. 12 .
  • FIG. 7 illustrates a perspective view of a segment of support structure 100 .
  • surface 105 of support structure 100 is textured or roughened to enhance bonding to tissue 125 (not shown).
  • Surface 105 can include raised or indented details that increase the surface area of support structure 100 .
  • surface 105 includes a coating or conformal layer having properties that enhance bonding, administer a drug, peptide, growth factor, chemical or other bioactive compound, provide insulation, increase electrical conductivity, or achieve another desirable result.
  • surface 105 includes a drug eluting coating.
  • FIGS. 8A , 8 B and 8 C illustrate sectional views of a segment of support structures 100 G, 100 H and 100 J, respectively.
  • support structure 100 G has a circular or round section and bears on tissue 125 at contact surface 80 A.
  • support structure 100 H has a rectangular section and bears on tissue 125 at contact surface 80 B.
  • support structure 100 J has a semi-circular section and bears on tissue 125 at contact surface 80 C.
  • the shape and size of contact surfaces 80 A, 80 B and 80 C are selected to provide a desired surface area of contact with tissue 125 .
  • support structure 100 is formed of wire or sheet stock.
  • support structure 100 is formed by rolling, etching, stamping, machining, casting, or by other fabrication means.
  • the support structure is placed in position using a cannula having an interior profile that matches that of a section of the support structure.
  • Support structure 100 can be formed of solid, hollow (or tubular), laminated or built-up structures including any of a variety of metals or non-metals.
  • Exemplary materials for support structure 100 include stainless steel, nitinol or other shape memory or superelastic material, and a polymer or biodegradable polymer.
  • Support structure 100 can include elastic or non-elastic materials. In one example, support structure 100 is non-magnetic.
  • the present subject matter includes a ring fabricated of a shape memory material and the ring is inserted through a tube through the pars plana region of the eye. Following insertion, body heat raises the temperature of the ring and causes the ring to transition from a first configuration or shape to a second configuration or shape.
  • the superelastic properties of the support structure allow it to be deformed significantly as it is introduced into the eye and return to its original shape once inside the eye.
  • FIG. 9 illustrates an exemplary support structure formed of separate semi-circular rings denoted as rings 100 K and 100 L.
  • rings 100 K and 100 L have approximately matching overall diameters and are fabricated of wire. The wire can be wound or rolled.
  • Features located at the ends of ring 100 K and ring 100 L include holes 106 .
  • Holes 106 can be blind holes, divots, dimples or through holes. In the example illustrated, holes 106 provide electrical contact with rings 100 K and 100 L. In one example, holes 106 are configured to receive a surgical tool that may help manipulate rings 100 K and 100 L.
  • ring 100 K serves as an electrical supply electrode and ring 100 L serves as an electrical drain electrode.
  • a current passing between the supply and drain electrodes serves to activate the support structure and thus bond to the tissue.
  • rings 100 K and 100 L present a relatively small footprint.
  • the surface area in contact with the tissue is small relative to the surface area of the tissue supported by the support structure.
  • FIGS. 10 and 13 illustrate tools 201 A and 201 B, respectively, with tool 201 B particularly suited for manipulating, placing and activating the structure illustrated in FIG. 9 .
  • the tool is used for capturing the graft and for insertion of the graft into the destination.
  • tool 201 A includes formed linear members 200 A and 200 B having ends 205 A and 205 B, respectively.
  • Linear members 200 A and 200 B are disposed in a lumen of cannulas 202 A and 202 B, respectively.
  • Cannulas 202 A and 202 B are disposed within a lumen of guide 210 A and an opposite end (not shown) provides access for manipulating, placing and activating a structure coupled to ends 205 A and 205 B.
  • ends 205 A and 205 B of tool 201 A are shaped in a manner that presents opposing convergent faces to facilitate coupling with a structure, such as that illustrated in FIG. 9 .
  • ends 205 A and 205 B are shaped in a manner that forms opposing divergent faces. Other configurations for ends 205 A and 205 B are contemplated.
  • Linear members 200 A and 200 B are formed of electrically conductive or non-conductive materials and can be laminated, coated, solid or hollow. Linear members 200 A and 200 B can be manipulated together or independent of each other.
  • tool 201 A is used to insert, place or position exemplary support structure 100 shown partially in the figure.
  • tool 201 A is used to deliver energy to bond support structure 100 to tissue.
  • ends 205 A and 205 B are shaped to enter holes of support structure 100 from opposite sides, however, in other examples, the ends enter holes or other features of support structure 100 from a single side.
  • Ends 205 A and 205 B are urged apart by a resilient force operating in the direction shown at arrows 20 .
  • Ends 205 A and 205 B can be drawn together by relative movement of guide 210 A in the direction shown by arrows 21 , or movement of cannulas 202 A and 202 B relative to guide 210 A.
  • cannulas 202 A and 202 B are configured for independent movement relative to each other as well as independent movement relative to guide 210 A.
  • FIG. 13 illustrates tool 201 B having curved linear members 200 C and 200 D in the positions shown. These members may be retracted into a straight configuration for insertion through a small incision. A portion of the length of linear members 200 C and 200 D is coated with a dielectric (such as polyimide). Bare ends 205 C and 205 D provide electrical connection to support structure 100 . For example, ends 205 C and 205 D can be manipulated to connect with features of a structure, including, for example, selected holes 106 of rings 100 K and 100 L.
  • Guide 210 A provides an insulative sheath by which linear members 200 C and 200 D can be manipulated. In one example, the support structure is manipulated based on relative motion between the guide 210 A and the linear members.
  • Ends 205 C and 205 D are shaped to engage a support structure for purposes of manipulating and activating the support structure.
  • ends 205 C and 205 D include elbow portions that allow insertion into receiving holes of a support structure from one side of the support structure. Other configurations for the ends are also contemplated.
  • Ends 205 C and 205 D as illustrated, facilitate delivery of electrical energy to an exemplary support structure.
  • FIG. 11 illustrates support structure 100 M having a circular configuration with loop feature 107 disposed at end 108 .
  • loop feature 107 includes a formed wire loop configured to engage with a device such as tool 201 A or tool 201 B.
  • FIG. 12A illustrates an embodiment of a support structure in a retracted position and FIGS. 12B and 12C illustrate alternative examples of the structure in a deployed configuration.
  • insulative sheath 210 D also referred to as a cannula
  • guides 210 B and 210 C also referred to as a cannula
  • guides 210 B and 210 C have a common sheath with a rotational component for manipulation of ring 100 N and ring 100 P either simultaneously or independently.
  • rings 100 N and 100 P are fabricated of elastic or shape memory material.
  • rings 100 N and 100 P can be distorted to a substantially linear configuration, as shown in FIG. 12A and later return to a formed configuration when external constraints or forces are removed (as with an elastic material) or upon transition from a first temperature to a second temperature (as with a shape memory material).
  • an intraocular infusion fluid (cooling or heating) can be used to trigger a transition of a shape memory material from a first configuration to a second configuration, in addition to controlling an intraocular temperature.
  • the cannula can have two lumens (as shown in the figures) or more than two lumens.
  • the multiple lumens of the cannula can each carry a pushrod for deployment, manipulation, or activation of a support structure.
  • each of insulative sheath 210 D, guide 210 B, guide 210 C, ring 100 N, and ring 100 P are configured for independent movement relative to each other.
  • guide 210 B can be manipulated independently relative to sheath 210 D as well as ring 100 N, ring 100 P and guide 210 C.
  • linear members 210 B and 210 C are configured in a curved or swept formation with each linear member deflecting a similar amount from a center line upon relaxation.
  • FIG. 12B illustrates a sectional view of insulative sheath 210 D penetrating a tissue wall 5 .
  • linear member 210 E is configured in an angular formation and linear member 210 C is configured in an unbent formation with linear member 210 E deflecting away from linear member 210 C.
  • linear member 210 E has a length that exceeds linear member 210 C when in a retracted position.
  • Linear member 210 E is configured with two hinge points or knees, however, in other examples, one or more of the linear members are shaped with more or less curvature.
  • FIG. 12D illustrates a portion of a support structure having ring 100 N disposed partially within a lumen of cannula 210 B.
  • Ring 100 N is shown in an uncoiled configuration.
  • ring 100 N includes a shape memory material.
  • Ring 100 N is ejected by a force applied to pushrod 80 , also disposed within a lumen of cannula 210 B.
  • both of ring 100 N and cannula 210 B have a curvature that facilitates placement (and extraction) of the support structure.
  • either one or the other of ring 100 N and cannula 210 B has a curvature.
  • Break 26 depicts the separate nature of pushrod 80 and ring 100 N.
  • break 26 includes a keyed joint, such as a tongue and groove, screw, or a spline, to allow rotational control of the support structure from the distal end of the pushrod.
  • Break 26 in one example, includes a weakened portion where pushrod 80 can be physically separated from ring 100 N by applying a force.
  • the curved cannula when disposed through the sclera, may reduce strain on the tissue wall of the eye and support structure during introduction into the eye.
  • ring 100 N is naturally coiled and when restrained by the confines of the lumen, maintains a substantially linear configuration but when ejected from within the lumen, it assumes a ring configuration.
  • Break 26 depicts the separate nature of pushrod 80 and ring 100 N.
  • Rings 100 N and 100 P for example can be separate from a pushrod or can be contiguous segments that are clipped or configured to break at a predetermined location, thus separating from the pushrod or other member that remains in the lumen.
  • a suitable shape memory material is selected to have a transition temperature based on the body temperatures encountered in the eye.
  • the support structure material is selected to retain a first shape or configuration at a first temperature (which can be greater than or less than that of the eye) and then resort to a second shape or configuration upon exposure to a second temperature different from the first temperature.
  • the material has elastic or superelastic properties.
  • Nitinol is an example of a shape-memory alloy and its shape-memory effect is due to a reversible austenite-martensite transformation. In the low-temperature regime, the alloy exists as a complex arrangement of atoms called martensite. As the alloy is heated through a transition temperature range, the alloy undergoes a solid-to-solid phase change to the highly ordered parent phase, called austenite. It is possible to control the transition temperature range by changing the nickel-titanium ratio, or by alloying with other metals. In one example, the nitinol structure that is introduced into the body has a transition temperature near body temperature. A nitinol structure can be cooled and compressed for delivery, and when deployed, it warms to body temperature, and returns to the parent shape.
  • Ni—Ti is an example of a shape memory material with superelastic properties used in biomedical applications.
  • Other alloys that exhibit shape memory properties include Cu—Al—Ni (copper-aluminum-nickel), Cu—Zn—Al (copper-zinc-aluminum), Au—Cd (gold-cadmium), and Ni—Al (nickel-aluminum).
  • Some shape memory alloys also exhibit superelastic behavior.
  • superelastic alloys examples include Cu—Al—Ni (copper-aluminum-nickel), Cu—Al—Mn (copper-aluminum-manganese), In—Pb (indium-lead), and Cu—Al—Be (copper-aluminum-beryllium).
  • Non-metallic materials are also contemplated for shape memory materials and superelastic materials.
  • a structure having a first shape can be deformed to allow passage through an opening or cannula through the sclera. Accordingly, to pass through the eye, the structure is deformed or partially uncoiled into a second configuration. After passing into the eye, the constraining force exerted by, for example, the cannula, is removed and the structure returns to the first configuration. Nitinol can sustain a strain below approximately 8% and exhibit the superelasticity property as described herein.
  • FIGS. 14A , 14 B and 14 C illustrate exemplary support structures having a variety of configurations.
  • Support structures 100 Q, 100 R, and 100 S are shown having a hemi-circular (half), semi-circular (partial), and unbent configuration, respectively.
  • a region of tissue 125 is illustrated underlying each support structure.
  • Each support structure 100 Q, 100 R and 100 S is disposed in guide 110 A.
  • a corresponding portion of a support structure (not illustrated) is disposed underneath tissue 125 .
  • the corresponding portion can have a similar or different size or configuration as the upper portion.
  • the tissue is cauterized in the regions illustrated by the radial lines underlying the support structures.
  • the support structure is illustrated as a straight segment.
  • the support structure includes a split or forked element that deploys to a “V” shaped segment in which case the perimeter of the “V” is cauterized and cut.
  • Other geometric configurations and sizes for support structures are also contemplated.
  • FIG. 15A illustrates a perspective view of a support structure having ring 100 T and ring 100 U positioned on opposite surfaces of a section of tissue 125 .
  • both ring 100 T and ring 100 U are illustrated in the form of split circular rings of a similar size.
  • Coagulated region 126 encircles a periphery of the support structure and penetrates through the entire depth of tissue 125 .
  • Cut 128 is disposed within coagulated region 126 and encircles a portion of the periphery of ring 100 T.
  • the subject matter of FIG. 15A is configured to form a free graft for translocation.
  • the split portions in rings 100 T and 100 U are illustrated near an edge of the tissue. Other locations or alignments of the splits are also contemplated.
  • the figure also illustrates holes disposed at the ends on either side of the splits. In one example, the holes facilitate manipulation and activation of the support structure.
  • a method includes placing the support structure about a target location on at least one surface of the tissue.
  • target 150 is encircled by both ring 100 T and ring 100 U.
  • coagulated region 126 is formed on a surface of tissue 125 around the periphery of the support structure. Cut 128 is formed within the coagulated region followed by removal or separation of target 150 from tissue 125 .
  • Target 150 is then translocated to a destination location and affixed in position.
  • ring 100 T and ring 100 U provide a support structure by which target 150 is manipulated and positioned.
  • target 150 is completely separated from tissue 125 by coagulating and cutting around the entire periphery.
  • the target tissue is partially separated from tissue 125 and a portion of the tissue and target remain contiguous.
  • FIG. 15B illustrates such an example with support structure 100 V disposed on an upper surface of tissue 125 .
  • a second portion of the support structure (not illustrated) is provided on a lower surface of tissue 125 .
  • Coagulated region 126 is formed around a portion of support structure 100 V and cut 128 is formed therein.
  • Target 150 is located proximate a portion of support structure 100 V and remains attached to tissue 125 at region 130 .
  • Region 130 is distorted when target 150 is rotated, or relocated, to a destination location by manipulating support structure 100 V and guide 110 A.
  • the subject matter illustrated in FIG. 15B allows formation and translocation of a pedicle graft where the target remains attached to the tissue and blood perfusion to the graft continues.
  • the cauterized region, and the incision are located very close to the perimeter of the support structure.
  • FIG. 16 illustrates a flow chart of method 300 according to the present subject matter.
  • a standard 3-port pars plana vitrectomy is performed, removing the core vitreous, lifting the posterior vitreous from the retinal surface, and removing the majority of the posterior vitreous gel.
  • the retina is detached.
  • the graft is harvested.
  • the graft is placed in position at the destination.
  • the retina is replaced.
  • FIG. 17 illustrates a flow chart of method 400 according to the present subject matter.
  • tissue is coagulated in order to reduce bleeding.
  • an incision is made to gain access to the suprachoroidal space.
  • support structure 100 is positioned proximate target 150 on tissue 125 .
  • support structure 100 is bonded to tissue 125 or other membrane.
  • tissue 125 around support structure 100 is coagulated.
  • graft or target 150 is detached from the surrounding tissue 125 .
  • graft 150 is relocated to the macular region, thereby supporting the neurosensory retina with a translocated autograft of healthy choroid, Bruch's membrane, and RPE.
  • the retina is left intact.
  • the full-thickness retina, RPE, Bruch's membrane, and choroid are coagulated using a thermal modality, such as pulsed laser.
  • a thermal modality such as pulsed laser.
  • an incision is made along the nerve fiber layers of the retina.
  • the posterior ring of a support structure is placed in the suprachoroidal space between the choroid and the sclera.
  • the anterior ring, aligned with the posterior ring is placed upon the innermost layer of the neurosensory retina.
  • the rings are activated, and the graft, (including choroid, Bruch's membrane, RPE, and neurosensory retina), is removed.
  • the neurosensory retina is then gently peeled away from the graft, leaving a layer of choroid, Bruch's membrane, and RPE supported by the structure.
  • the graft is then inserted as described.
  • the support structure is placed and positioned without detaching the superior retina at a localized position.
  • a small blister, or induction of a serous retinal detachment is made and an incision is made in the nerve fiber layers in a direction parallel to the grain of the fibers.
  • the support structure is inserted under the separated nerve fiber layer.
  • the translocation procedure includes removing the damaged tissue underlying the retina.
  • the damaged tissue remains in place and the translocated patch of choroid, Bruch's membrane, and RPE is placed beneath the retina in a position on top of the original damaged tissue. Over time, new vessels grow through the original tissue to perfuse the new graft. The removal of the damaged tissue underlying the macula is optional.
  • FIG. 18 illustrates a view of an excised autologous graft of choroid, Bruch's membrane, and RPE supported by a support structure including two nitinol rings. Tissue 125 is held in a position that reveals the RPE with underlying layers not visible. Anterior ring 100 A is largely visible and portions of posterior ring 100 B are visible only where the cauterized tissue is cut closer to the rings. Prior to harvest of the graft, posterior ring 100 B is positioned between the sclera and the choroid. Forceps 32 is shown gripping ring 100 A and 100 B.
  • tissue other than choroid, Bruch's membrane, and RPE is manipulated and translocated using the present subject matter.
  • other vascular tissue includes the choroid plexus in the central nervous system, vascular complexes in the gastrointestinal system including the small bowel, colon and stomach tissue, vascular plexus of the bladder or urinary tract system, pericardium with its inherent microvasculature, meninges surrounding the central nervous system, vascular plexus surrounding nerve tissue, subcutaneous vascular tissue (subdermal), vascular complexes in the sinuses or oral mucosa, nasal pharynx or esophagus.
  • fluid is introduced under the retina into the subretinal space to aid in detachment of the retina.
  • the present subject matter is configured to facilitate transplantation of healthy RPE with a full-thickness patch of underlying Bruch's membrane and choroid.
  • the present subject matter can be used to harvest and translocate a patch of tissue while maintaining the shape, size, and polarity of the patch or graft.
  • an autologous graft of choroid, Bruch's membrane, and RPE is moved to the subfoveal area and placed beneath the macula.
  • the present subject matter may eliminate the problem of torsional diplopia, a tilted horizon in the surgical eye that sometimes results from macular translocation surgery.
  • a temporary, surgical retinal detachment provides access for the surgery. The retina is reattached in its original position and maintains normal orientation.
  • a flap (shaped like a peninsula) of healthy choroid, Bruch's membrane, and RPE is repositioned by rotation of the flap under the retina to replace a region of damaged choroid, Bruch's membrane, and RPE that is no longer capable of supporting the photoreceptors in the retina.
  • the flap, or pedicle remains connected to the choroidal blood supply to nourish the flap tissue.
  • a free, autologous graft of healthy choroid, Bruch's membrane, and RPE is harvested from the patient's eye and repositioned under the macula. The neovascularization from the choroid will vascularize the graft.
  • an allograft tissue transplanted from a donor to a recipient
  • the host is subjected to immunosuppression since the graft would be treated as foreign tissue by the recipient's immune system.
  • the graft can be obtained from a cadaveric source such as an eye bank.
  • tissue from the fellow eye is used as an autograft, thereby avoiding immune barriers.
  • tissue including choroid, Bruch's membrane, and RPE
  • tissue including choroid, Bruch's membrane, and RPE
  • a patch includes a synthetic graft.
  • a synthetic graft can be grown in vitro, from, for example, donor stem cells, iris cells, or other sources.
  • a layer of photoreceptor cells is implanted on a support structure as described herein and used to replace cellular elements lost in other retinal degenerative conditions such as retinitis pigmentosa.
  • Coagulation around the patch can damage the RPE. Additionally, Bruch's membrane has a tendency to shrink when exposed to energy that is capable of coagulating choroidal blood vessels.
  • the shape and orientation of the graft is maintained by the support structure while repositioning the graft, thus reducing the amount of tissue damaged during the process.
  • An index mark or a feature position can be used as a reference to maintain alignment of the graft orientation.
  • the index mark or feature can be disposed on one or more portions of the support structure.
  • a micro-pulsed diode laser is used to coagulate the periphery of the patch.
  • the laser is operated with particular parameters as to maximum power, length of pulse and length of interval between pulses.
  • Typical radio frequency (RF) generators for intraocular devices have a maximum power in the range of 12-15 W.
  • the support structure is bonded to the tissue using a power level ranging from about 1 W to 10 W. Parameters for bonding the tissue to the support structure, including power level, pulse duration, and frequency can be established experimentally.
  • a foot pedal is used to apply power to the electrodes momentarily.
  • the device is operated briefly to tack the support structure into position at one or more locations around the periphery.
  • some regions of tissue stick to the electrodes, thus forming a thin layer of insulation.
  • the power is slightly increased in order to maintain the same activation or bonding effect. If excessive tissue sticks to the electrodes, increased power levels have little effect and the electrodes can be cleaned to restore bonding effectiveness.
  • the support structure includes an implantable structure of biocompatible metal to support the graft during harvest and facilitates repositioning of the graft.
  • the support structure is in the form of a ring or other structure having an approximately circular shape.
  • the support structure is fabricated of a shape memory material such as nitinol (a nickel titanium alloy originally developed at the Naval Ordnance Laboratory). Nitinol has shape-memory characteristics that allow it to be folded into a compact shape for insertion through a small tube (for example, a 20 gauge blunt needle) inserted into the eye, and then deployed (by exposure to body temperature) to return to its memory position for use as a support structure.
  • nitinol a nickel titanium alloy originally developed at the Naval Ordnance Laboratory
  • Nitinol has shape-memory characteristics that allow it to be folded into a compact shape for insertion through a small tube (for example, a 20 gauge blunt needle) inserted into the eye, and then deployed (by exposure to body temperature) to return to its memory position for use as a support structure.
  • the support structure is inserted or retracted using a guide of 18 gauge (approximately 1.02 mm diameter); however, larger or smaller diameters are also contemplated. Entry sites through the sclera (sclerotomy) may range from 25 gauge to 18 gauge or larger.
  • the support structure is bonded to the graft and provides a structure with which to manipulate and position the graft, or patch.
  • the orientation and polarity of the RPE cells remain aligned with that of the surrounding tissue.
  • the support structure includes two rings, one on top of the RPE and one beneath the choroid and each serves as an electrode for applying pulsed radio frequency (RF) energy.
  • the two rings bond to the tissue and provide support for the graft.
  • a bipolar device and a signal generator are used for delivering RF energy to the support structure.
  • a bipolar scissors can be used for cutting and coagulation.
  • an intraocular (bipolar) forceps is adapted to activate the support structure.
  • the support structure includes members disposed on one or two surfaces of the graft.
  • the support structure can also be bonded using a monopolar device. In a monopolar device, RF current flows in the tissue between a small active electrode and a passive, neutral or dispersive electrode which has a much larger surface area. In a bipolar device, RF current flows in the tissue between two closely spaced electrodes.
  • laser ablation and cutting are used around the outer periphery of the support structure of the choroid, Bruch's membrane, and RPE tissue.
  • the upper and lower (or first and second) rings of a support structure are clamped in concentric alignment to elevate and separate tissue, protect the RPE cellular layer or other delicate monocellular layers that are being translocated, and to separate tissue on either side of the choroid, Bruch's membrane, and RPE.
  • air in the form of bubbles
  • fluid such as balanced salt solution, perfluorocarbon liquid, hyaluronate, or other viscoelastic agent
  • the bubbles, fluids, or liquids can also be used in the insertion site to protect delicate cellular layers, and prevent injury.
  • the graft is positioned between the existing RPE and the neurosensory retina (photoreceptors) in the macular region.
  • the graft is centered to support the fovea.
  • the fovea of the neurosensory retina is positioned to lie at the center of target 150 .
  • a laser is used to cauterize tissue around the graft.
  • the support structure is fabricated of biodegradable material and thus, breaks down after a predetermined period following translocation of the graft.
  • the support structure is encased in a naturally occurring fibrous capsule and remains in position following translocation of the graft.
  • the support structure includes a feature, such as a tab, that facilitates manipulation and positioning of the graft.
  • the support structure is used to cauterize the tissue around the graft.
  • electrically conductive rings can serve as cauterizing electrodes and the rings are placed and positioned using forceps or another tool having electrically charged contacts.
  • the tool includes a vertically acting forceps.
  • the tool is manipulated through a guide having a diameter of approximately 2 mm.
  • the forceps are used to insert the support structure through a guide as well as to grasp, position, and activate the support structure.
  • access to the graft is provided (for either retrieval or insertion) through the sclera by creating a larger scleral opening externally with standard blades and addressing the choroid with laser, diathermy, or cautery.
  • the support structure includes two members that are positioned with one on either surface of the tissue.
  • the two members are aligned by manual alignment, a hinge, a pivoting bracket or aligned by a placement structure as illustrated herein.
  • the members of the support structure are aligned by visually noting deflection telegraphed through from an opposite side of the tissue.
  • a layer of oxide is removed from a metal support structure to facilitate bonding to the tissue.
  • the surface of the support structure is modified to enhance bonding.
  • exemplary modifications include roughening, scoring, serrations, or ridges on the surface of the support structure.
  • the support structure is positioned by means of a linear incision or a pierced hole.
  • the support structure can be distorted or collapsed into a first configuration and inserted into position and thereafter deployed or allowed to revert to a second configuration.
  • the support structure is affixed in position by an activation process that produces a change in collagen as energy is delivered, thus causing the tissue to adhere to the support structure.
  • Activation can include application of thermal energy (freezing or heating current), RF energy, electric current or optical energy.
  • RF energy radio frequency
  • a radio frequency (RF) bipolar generator is used to activate the support structure and form a bond with the tissue.
  • a biocompatible adhesive is used to bond the support structure to the tissue.
  • a laser light source is directed around the periphery of the support structure to coagulate the blood around the graft.
  • low level pulsed energy is applied to avoid shriveling, shrinkage and tissue damage.
  • the power level is approximately 750 milliwatts and the pulse interval is reduced to deliver sufficient energy per unit time in order to coagulate.
  • the line can be traced repeatedly in order to produce an acceptable burn.
  • the absorption rate also depends on the level of pigmentation in the eye. For example, in micropulse mode with an 810 nm diode laser, a power of approximately 850 mW, a pulse duration of 100 microseconds, and a pulse interval of 500 microseconds can produce effective results. Other power levels, durations and intervals are also contemplated. In one example, the power level may be in the range of 500 mW to 2000 mW depending on the level of pigmentation and other factors.
  • a tab or other feature is provided on a support structure and energy is coupled to the support structure by the feature.
  • the laser energy is directed at the tissue and measures are taken to avoid absorption by the support structure.
  • a coating or sacrificial structure (such as an additional wire ring) is provided to reduce losses at the support structure.
  • the laser energy is directed around the support structure by manual manipulation of a tool or by indexing off the support structure.
  • the support structure includes a side-emitting optical fiber element and optical energy pulsed in the fiber serves to ablate or coagulate the tissue around the graft.
  • the support structure is treated with a pro-vascular or an anti-vascular drug to modulate perfusion of the graft following translocation.
  • the drug is incorporated as a drug eluting coating on the support structure.
  • a scleral depressor is used to place the support structure in position.
  • an external thrust device can be used to apply a pressure to a portion of the sclera to facilitate identification of the target site. The blood vessels will appear blanched and thus provide a guide as to cauterizing.
  • choroidal blood vessels are blanched to facilitate coagulation. Blanching can reduce the thermal spread of vascular blood flow to surrounding tissues (radiator effect) and thus also allow closure of vessels without actively flowing blood.
  • blanching before coagulating may allow the laser energy level to be lower.
  • the tissue may coagulate with reduced thermal damage if tamponade is provided by, for example, an external scleral depression device, sufficient to blanch the choroidal tissue.
  • Application of visible light (illumination) in conjunction with scleral depression can facilitate identification of the blanched tissue.
  • selected drugs or factors are used with the support structure to enhance engraftment.
  • exemplary anti-angiogenesis drugs include LucentisTM (ranibizumab, a humanized anti-VEGF antibody fragment that inhibits activity) or MACUGEN® (pegaptanib sodium injection) and exemplary pro-angiogenic peptides such as VEGF.
  • LucentisTM randomibizumab, a humanized anti-VEGF antibody fragment that inhibits activity
  • MACUGEN® pegaptanib sodium injection
  • exemplary pro-angiogenic peptides such as VEGF.
  • a first drug or surface treatment is used on a first member of a support structure and a different or second drug or surface treatment is used on a second member of the support structure.
  • a balloon depressor or other structure to depress the sclera is used to compress a target area. After depressing the target area, a laser is used to coagulate the surrounding tissue. After removing the depressor (or deflating the balloon), the support structure is introduced and placed in position on one or both sides of the tissue. The graft is then excised by cutting followed by translocation and re-implantation. In one example, a scleral depressor is used to tamponade the choroidal blood flow to improve coagulation.
  • the depressor can facilitate blanching of the blood vessels.
  • the tissue blanches, or turns a pale color when pressure is applied.
  • pre-existing tissue is removed from the destination site prior to translocation and re-implantation.
  • the graft is translocated and re-implanted without removal of pre-existing tissue.
  • the support structure members are disposed on the first and second surface of the tissue and are spaced apart by a distance of approximately 400-500 microns. In various examples, the support structure members are spaced apart by a dimension less than 400 microns and in other examples, by a dimension greater than 500 microns.
  • the support structure members are separated to reduce or eliminate damage to the tissue, particularly the RPE, by scraping.
  • a portion of the support structure is coated with a material selected to protect the RPE, such as a viscoelastic substance, and thereby reduce loss of RPE.
  • the tissue is coagulated on either one or both surfaces.
  • an incision is formed on either one or both surfaces.
  • the support structure is affixed to one surface of the tissue and an opposite surface of the tissue is coagulated.
  • the support structure is affixed to one surface of the tissue and an opposite surface of the tissue is cut. The tissue is cut with a scissors, a laser, a diamond blade, or other cutting tool.
  • FIGS. 19A and 19B illustrate sectional views of portions of a support structure.
  • support structure 190 A includes ring 192 A and ring 194 A.
  • Ring 192 A has a substantially rectangular cross section with groove 191 disposed on the tissue contact surface.
  • Ring 194 A has a substantially rectangular cross section with tongue 193 disposed on the tissue contact surface. Tongue 193 and groove 191 are configured to match and facilitate alignment of ring 192 A and ring 194 A disposed on opposite sides of the membrane (not shown).
  • the two rings of a support structure are aligned by a series of raised dimples or spikes on one ring and a corresponding series of depressions or holes on the second ring.
  • the combination of protruding portions and receiving portions may facilitate holding the support structure in position relative to the tissue.
  • support structure 190 B includes ring 192 B and ring 194 B.
  • Ring 192 B and ring 194 B have sections corresponding to partially flattened round stock. The round stock can be flattened by rolling.
  • Ring 192 B and ring 194 B are held in alignment by hinge 195 .
  • Hinge 195 in various examples, includes a flexible element or mechanical structure that allows limited movement of ring 192 B relative to ring 194 B.
  • hinge 195 includes a shape memory material.
  • FIGS. 20A , 20 B and 20 C illustrate exemplary features for manipulating the support structure.
  • support structure 250 A is affixed to feature 260 .
  • Feature 260 includes a ball-like structure that is configured for grasping by a manipulator having a corresponding cup-shaped element.
  • support structure 250 B includes feature 262 disposed on a surface.
  • Feature 262 in the figure, includes a hole or cavity that receives a manipulator having a corresponding element.
  • the hole includes a “t-slot” or other shaped element that allows an operator to manipulate, control and engage the support structure.
  • FIG. 20A for example, support structure 250 A is affixed to feature 260 .
  • Feature 260 includes a ball-like structure that is configured for grasping by a manipulator having a corresponding cup-shaped element.
  • support structure 250 B includes feature 262 disposed on a surface.
  • Feature 262 in the figure, includes a hole or cavity that receives a manipulator having a
  • manipulator 276 engages a corresponding feature of support structure 250 C.
  • manipulator 276 includes ramped portions 272 that engage hole 261 in the support structure 250 C.
  • Notch 274 of manipulator 276 engages the surfaces of hole 261 of support structure 250 C following deflection of ramped portions 272 and insertion of the manipulator into hole 261 .
  • Other configurations of features are also contemplated for engaging the support structure for purposes of manipulating during placement and activation.
  • a feature affixed to, or integral with, the support structure can be used to selectively apply a torque or other force to generate compressive pressure on a selected portion of a ring or rings.
  • a feature can be used for delivering energy (RF) such as for purposes of activating (bonding) or disbonding the support structure and the membrane.
  • RF energy
  • Features distributed about the support structure can be used for selective activation. For example, one support structure illustrated herein includes four features.
  • FIGS. 21A and 21B illustrate portions of exemplary manipulators suitable for use with a particular support structure.
  • manipulator 270 A includes parallel clamping surfaces 275 .
  • the clamping surfaces travel in a linear manner and remain parallel when operated by legs 272 .
  • Legs 272 are at an angle of approximately 60-70 degrees with respect to the clamping surfaces, however other angles are also contemplated.
  • clamping surfaces 277 are set at an angle that causes a work piece to be clamped at a corresponding angle.
  • a support structure can be manipulated or clamped so that one portion makes contact with the membrane before another portion of the support structure.
  • the manipulator includes a pair of forceps, a micro-manipulator or a remotely operable actuator. Forceps are a hand-held instrument used for grasping and holding an object.
  • FIGS. 22A and 22B illustrate structures for keeping the membrane from being torn or for treating a torn membrane.
  • Support structure 280 shown in FIG. 22 A includes ring 282 bonded to mesh 284 .
  • Mesh 284 is affixed to a tissue contact surface of ring 282 and provides a structure that supports torn tissue disposed within the circumference of ring 282 .
  • Mesh 284 includes a biocompatible material and can include a bioerodable material, a biodegradable material, an elastic material or other substance.
  • FIG. 22B illustrates ring 286 having hole 287 disposed in a surface.
  • hole 287 is a blind hole, however, through holes can also be used.
  • hole 287 includes internal splines, threads, clamps or other features that engage a corresponding structure of support 290 .
  • Support 290 includes leg 288 and hook 292 . Hook 292 engages a portion of tissue and exerts a force that stabilizes a torn tissue based on the fixed alignment between support 290 and ring 286 .
  • Support 290 in various examples, includes a metal or polymer structure.
  • FIG. 23 illustrates a view of support structure 350 A having a generally circular shape.
  • shape refers to a two-dimensional configuration when viewed from above.
  • Support structure 350 A includes a plurality of features 352 A, 352 B, 352 C, and 352 D.
  • the features illustrated include four tabs uniformly distributed about the circumference, however, more or fewer features and different placement are also contemplated.
  • the features allow manipulation or activation of the support structure.
  • the features are held in a closed or retracted position by material properties selected for the feature.
  • a shape memory material can be selected to provide a retracted position as shown by features 352 A, 352 B, and 352 C and when activated by temperature or other energy source, the features are deployed as shown by feature 352 D.
  • Thermal energy can be provided by an external source or by natural body temperature.
  • Radio frequency energy can be provided by a suitably configured manipulator or forceps.
  • the features are electrically isolated from the ring of support structure 350 A. An electrically isolated feature allows the surgeon to selectively bond the feature to the membrane.
  • a shape memory material provides a retracted position as shown by feature 352 A or a partially or fully retracted position in which the feature is flush with a surface of support structure 350 A. In a flush position, the feature is disposed in a cavity or channel in a manner similar to a folding blade of a pocket knife.
  • FIG. 24 illustrates a cross section of a portion of a support structure.
  • the support structure includes a first ring 240 A disposed on a first surface of membrane 125 .
  • a second ring 242 is disposed on a second surface of membrane 125 , and in one example, the second surface includes the RPE layer.
  • Second ring 242 includes two electrical conductors separated by an insulator or dielectric 246 .
  • the dielectric can include an oxide layer.
  • ring 244 and ring 248 are concentric. Rings 240 A, 244 , and 248 are separately accessible by way of features disposed about the support structure and when energized, bond to the membrane.
  • second ring 242 can be placed on the RPE in a manner that avoids scraping or damage to the cells on the surface of the membrane. Once placed in position, energy can be applied to the two conductors of second ring 242 , thus bonding the second ring to the membrane. After placing second ring 242 in position, first ring 240 A can be positioned and bonded to the membrane. First ring 240 A can be activated by applying energy to one or both of ring 244 and ring 248 .
  • second ring 242 (including ring 244 , ring 248 and dielectric 246 ) are separate elements or of a unitary construction.
  • the support structure includes a single ring or other structure (configured for placement on a single side of the tissue) where the ring or other structure has a portion including two electrical conductors separated by an insulator or dielectric.
  • graduated portion 43 of the ring illustrated in FIG. 4D can include two electrically isolated conductors that can be used to apply bonding energy.
  • tab 41 (of the ring illustrated in FIG. 4C ) or tab 45 (of the ring illustrated in FIG. 4E ) can include two electrically isolated conductors that can be used to apply bonding energy. This structure allows a surgeon to both manipulate the rings (+ or ⁇ pole) as well as activate the rings using an energy source such as radio frequency.
  • FIGS. 25A and 25B illustrate portions of support structures having segmented insulators.
  • electrically conductive portions of the support structure are exposed at 266 A.
  • Insulators 264 A shield selected portions of the support structure.
  • a bond is readily formed between the support structure and the membrane by applying monopolar RF energy.
  • the support structure includes a pair of adjacent electrical conductors, each having segmented insulators.
  • electrically conductive portions of the support structure are exposed at 266 A and 266 B.
  • Insulators 264 A and 264 B shield selected portions of the support structure. At exposed portions 266 A and 266 B, a bond is readily formed with the tissue disposed between the adjacent rings of the support structure by applying bipolar RF energy.
  • FIGS. 23 , 24 , and 25 exemplify various means of attaching a support structure to a tissue surface using RF energy.
  • Other means are also contemplated and can generally be described as having two conductors, relatively closely spaced, and separated by a dielectric or insulator.
  • the two conductors are disposed at intervals, thus forming regions where the conductors are very close.
  • the conductors can be positioned to contact the tissue so that RF energy applied to the conductors passes through a circuit including the two conductors as well as the tissue adjacent the separating insulator.
  • FIG. 26 illustrates a partial sectional view of an example in which a feature includes two electrically isolated conductors.
  • Feature 352 E is affixed to support structure 350 B.
  • Feature 352 E includes a first electrical conductor 362 A, which is isolated from the support structure by insulator 364 A, and a second electrical conductor 362 B, which is isolated from the support structure by insulator 364 B.
  • Bipolar RF energy can be applied to conductor 362 A and conductor 362 B, and when the device is in contact with tissue, a bond is formed by the current in the tissue.
  • Particular embodiments of the present subject matter can be used to maintain a fixed shape of the excised graft and facilitate translocation.
  • a tissue contact surface of the support structure is bonded to the membrane and resists the tendency of the excised tissue to distort or shrink.
  • the graft is supported by the support structure and a feature of the support structure facilitates translocating the graft along with the support structure.
  • the support structure remains permanently bonded to the graft after placement of the graft in the new position in the eye.
  • the support structure is of a temporary nature and can be selectively disbonded from the graft after translocating the graft and before formation of a fibrous capsule.
  • the graft can be disbonded by various means including application of an electric current, exposure to a chemical releasing agent or by mechanical removal.
  • the support structure can be configured to harvest and translocate a graft in the form of a pedicle or a circular (or other closed) shape.
  • the support structure can be fabricated by electrical discharge machining (EDM), by photolithography or other semiconductor fabrication technology.
  • EDM electrical discharge machining
  • Manipulation of the support structure can endanger the RPE or cause a tear or other damage. Such hazards can be mitigated by an embodiment of the present subject matter including a mesh or screen that encircles the support structure.
  • the mesh or screen can be disposed on one or both sides of the membrane.
  • a tool is engaged with a hole in the surface of the support structure (a through hole or a blind hole) and an end of the tool stabilizes the adjacent membrane. Retraction of the support structure would also mitigate injury to the surrounding tissues.
  • the support structure is configured for use on one side of the membrane. As such, the support structure is bonded to the RPE side or the choroid side of the membrane. In one example, the support structure is configured for use on two sides of the membrane and the graft is sandwiched between.
  • the features are used to deliver RF energy sufficient to tack the support structure to the membrane.
  • the RF energy is delivered at multiple sites (or features) distributed about the periphery.
  • the features are electrically isolated from a main electrode and energy is selectively applied to activate particular portions.
  • the features include isolated electrodes that are selectively deployable.
  • the features maintain a retracted position until energized (by body temperature or above, or electrical energy) and are deployed to allow harvesting of the graft.
  • each feature includes a two-conductor element that can be selectively bonded to underlying tissue using bipolar RF energy or laser energy.
  • the support structure includes a ring having a diameter of 3-5 mm.
  • a posterior ring of the support structure is inserted into the suprachoroidal space and an anterior ring of the support structure is placed on the RPE.
  • the two rings are aligned with each other over the donor site.
  • a source of RF energy is applied to the two rings which serve as electrodes. The RF energy causes the tissue to bond to the rings.
  • the anterior ring includes at least two separate conductors and is positioned on the RPE surface.
  • the separate conductors of the support structure are electrically isolated and when coupled to a RF energy source, serve as electrodes to bond the anterior ring to the tissue.
  • the posterior ring is aligned and placed in position in the suprachoroidal space. This procedure may reduce the incidence of damage to the RPE surface.
  • the graft is carried to the translocation site by maneuvering and manipulating the support structure after excising the tissue from the membrane.
  • the target (or translocation) site underlies the macula. Reattachment of the retina will likely hold the graft in position by the natural RPE pumping mechanism that dehydrates the subretinal space. This creates a “vacuum seal” of the graft and support ring in position.
  • the graft can be held in position by tacking the support structure to the membrane at the new site.
  • Features or other small electrode elements of the support structure can be used to fix the graft in position. The features or other small electrodes may be the same or different from those features used for affixing the support structure at the donor site. It is expected that blood vessels from the native choroid will grow into the graft, vascularize the donor tissue, and help secure the tissue in position.
  • the support structure includes a double ring structure.
  • an outer ring remains at the donor site, and the inner ring, which is bonded to the graft tissue, disengages from the outer ring, and is relocated to the target site.
  • This configuration allows a compressive ring at the recipient site (to prevent shrinkage), and compression ring at the donor site (to prevent bleeding).
  • a bioadhesive serves as the support structure as well as a bonding agent for attachment to the graft.
  • the bioadhesive is compatible with the body environment and can be applied to one or more tissue layers.
  • the bioadhesive cures to a rigid or semi-rigid state and provides support for the excised graft.
  • the support structure is mechanically coupled to the graft.
  • a graft is disposed between a support structure having two clamping surfaces (as shown in FIGS. 19A and 19B ).
  • a mechanical clamping force sandwiches the tissue between the two surfaces.
  • the surrounding tissue is coagulated and the graft is excised without having activated the support structure.
  • a clamping force can be described as a mechanical bond.
  • a manipulation tool is integrated as a unit with the support structure.
  • the manipulation tool portion is not readily separable from the support structure portion and the unit is used for both harvesting and placing of the graft after which the unit is wholly removed from the eye.
  • the guide (tool) remains attached to the support structure.
  • This document discusses, among other things, a system of translocating a graft for treatment of age-related macular degeneration. Structural support devices, manipulation tools and corresponding methods are described. In the case of an external source of tissue, one method includes forming an incision to accommodate insertion of the graft.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Physics & Mathematics (AREA)
  • Vascular Medicine (AREA)
  • Otolaryngology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Optics & Photonics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Electromagnetism (AREA)
  • Transplantation (AREA)
  • Cardiology (AREA)
  • Plasma & Fusion (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
US11/502,603 2006-01-31 2006-08-09 Surgical support structure Abandoned US20070179512A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US11/502,603 US20070179512A1 (en) 2006-01-31 2006-08-09 Surgical support structure
US14/499,404 US10278808B2 (en) 2006-01-31 2014-09-29 Surgical support structure
US14/696,957 US20150223929A1 (en) 2006-01-31 2015-04-27 Surgical support structure

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US76353606P 2006-01-31 2006-01-31
US11/502,603 US20070179512A1 (en) 2006-01-31 2006-08-09 Surgical support structure

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US14/499,404 Division US10278808B2 (en) 2006-01-31 2014-09-29 Surgical support structure
US14/696,957 Division US20150223929A1 (en) 2006-01-31 2015-04-27 Surgical support structure

Publications (1)

Publication Number Publication Date
US20070179512A1 true US20070179512A1 (en) 2007-08-02

Family

ID=37488086

Family Applications (3)

Application Number Title Priority Date Filing Date
US11/502,603 Abandoned US20070179512A1 (en) 2006-01-31 2006-08-09 Surgical support structure
US14/499,404 Active 2027-07-04 US10278808B2 (en) 2006-01-31 2014-09-29 Surgical support structure
US14/696,957 Abandoned US20150223929A1 (en) 2006-01-31 2015-04-27 Surgical support structure

Family Applications After (2)

Application Number Title Priority Date Filing Date
US14/499,404 Active 2027-07-04 US10278808B2 (en) 2006-01-31 2014-09-29 Surgical support structure
US14/696,957 Abandoned US20150223929A1 (en) 2006-01-31 2015-04-27 Surgical support structure

Country Status (4)

Country Link
US (3) US20070179512A1 (fr)
EP (1) EP1986581B1 (fr)
AU (1) AU2006337171A1 (fr)
WO (1) WO2007089277A1 (fr)

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080074617A1 (en) * 2004-03-11 2008-03-27 Oti Ophthalmic Technologies Inc. Method and Apparatus for Displaying Oct Cross Sections
US20090261804A1 (en) * 2008-04-22 2009-10-22 Tyco Healthcare Group Lp Jaw Closure Detection System
US20100298840A1 (en) * 2009-05-22 2010-11-25 Schwartz Lyman D Phimosis Treatment Device and Method
WO2011059908A1 (fr) * 2009-11-13 2011-05-19 Circulite, Inc. Stabilisateur de canule
US20110144667A1 (en) * 2009-09-08 2011-06-16 Anthony Richard Horton Hernia patch
WO2011066451A3 (fr) * 2009-11-24 2011-10-13 Olsen Timothy W Structure de support de tissu
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
US9433725B2 (en) 2011-12-23 2016-09-06 Alcon Research, Ltd. Combined coaxial and bimanual irrigation/aspiration apparatus
US20160290377A1 (en) * 2015-04-06 2016-10-06 Koncept Technologies Inc. Telescoping joint
US9839738B2 (en) 2013-06-06 2017-12-12 Novartis Ag Transformer irrigation/aspiration device
US10039565B2 (en) 2012-12-13 2018-08-07 Alcon Research, Ltd. Fine membrane forceps with integral scraping feature
US10278808B2 (en) 2006-01-31 2019-05-07 Emory University Surgical support structure
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
US10973682B2 (en) 2014-02-24 2021-04-13 Alcon Inc. Surgical instrument with adhesion optimized edge condition
US10987119B2 (en) 2016-10-18 2021-04-27 Alcon Inc. Surgical instrument having a surface texture
US11653928B2 (en) 2018-03-28 2023-05-23 Datascope Corp. Device for atrial appendage exclusion

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9149388B2 (en) * 2010-09-29 2015-10-06 Alcon Research, Ltd. Attenuated RF power for automated capsulorhexis
CN106456365B (zh) * 2014-05-07 2019-12-13 侯赛因·耶梯柯 黄斑裂孔修复仪器
CN108416793B (zh) * 2018-01-16 2022-06-21 武汉诺影云科技有限公司 基于三维相干断层成像图像的脉络膜血管分割方法及系统
US20230157871A1 (en) * 2020-07-15 2023-05-25 Imacular Regeneration Llc Tissue graft fixture

Citations (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3927471A (en) * 1973-02-02 1975-12-23 Keith Arthur Tricker Electronic circuits
US4043564A (en) * 1974-05-28 1977-08-23 Garlock Inc. Pitman shaft boot seal
US4224934A (en) * 1979-04-11 1980-09-30 American Medical Systems, Inc. Medical prosthetic pull valve and system for using same
US5527356A (en) * 1994-08-02 1996-06-18 Syntec, Inc. Retinal plug
US5653752A (en) * 1995-02-28 1997-08-05 Keravision, Inc. Adjustable devices for corneal curvature adjustment
US5755716A (en) * 1996-08-30 1998-05-26 Garito; Jon C. Method for using an electrosurgical electrode for treating glaucoma
US5817075A (en) * 1989-08-14 1998-10-06 Photogenesis, Inc. Method for preparation and transplantation of planar implants and surgical instrument therefor
US5962027A (en) * 1989-08-14 1999-10-05 Photogenesis, Inc. Retinal cell transplant
US6045791A (en) * 1992-03-06 2000-04-04 Photogenesis, Inc. Retinal pigment epithelium transplantation
US6156042A (en) * 1997-11-17 2000-12-05 Aramant; Robert B. Retinal tissue implantation instrument
US6165042A (en) * 1998-11-10 2000-12-26 Chin; Lin-Chi Bob toy device
US6514238B1 (en) * 1989-08-14 2003-02-04 Photogenesis, Inc. Method for preparation and transplantation of volute grafts and surgical instrument therefor
US20030105456A1 (en) * 2001-12-04 2003-06-05 J.T. Lin Apparatus and methods for prevention of age-related macular degeneration and other eye diseases
US20040039401A1 (en) * 2000-03-31 2004-02-26 Chow Alan Y. Implant instrument
US20040254567A1 (en) * 2003-02-12 2004-12-16 Holz Frank G. Surgical method for ablating tissue
US20060002900A1 (en) * 2002-10-04 2006-01-05 Susanne Binder Retinal pigment epithelial cell cultures on amniotic membrane and transplantation
US20060110428A1 (en) * 2004-07-02 2006-05-25 Eugene Dejuan Methods and devices for the treatment of ocular conditions

Family Cites Families (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2094463A1 (fr) * 1992-04-28 1993-10-29 Claude Vidal Pinces pour vaisseaux
JP3278277B2 (ja) 1994-01-26 2002-04-30 キヤノン株式会社 投影露光装置及びこれを用いたデバイス製造方法
US5540701A (en) 1994-05-20 1996-07-30 Hugh Sharkey Passive fixation anastomosis method and device
US5487746A (en) 1994-11-23 1996-01-30 Yu; George W. Surgical clip having a longitudinal opening through which clamped tissue protrudes
US6015417A (en) 1996-01-25 2000-01-18 Reynolds, Jr.; Walker Surgical fastener
US6193732B1 (en) 1999-01-08 2001-02-27 Cardiothoracic System Surgical clips and apparatus and method for clip placement
US6159218A (en) 1999-05-19 2000-12-12 Aramant; Robert B. Retinal tissue implantation tool
US6391038B2 (en) * 1999-07-28 2002-05-21 Cardica, Inc. Anastomosis system and method for controlling a tissue site
US6790218B2 (en) 1999-12-23 2004-09-14 Swaminathan Jayaraman Occlusive coil manufacture and delivery
US6896684B2 (en) 2000-06-12 2005-05-24 Niti Medical Technologies Ltd. Surgical clip applicator device
IL136702A (en) 2000-06-12 2005-11-20 Niti Alloys Tech Ltd Surgical clip
US8361110B2 (en) 2004-04-26 2013-01-29 W.L. Gore & Associates, Inc. Heart-shaped PFO closure device
US7842053B2 (en) 2004-05-06 2010-11-30 Nmt Medical, Inc. Double coil occluder
US7718109B2 (en) 2005-02-14 2010-05-18 Mayo Foundation For Medical Education And Research Tissue support structure
US9480480B2 (en) 2005-12-22 2016-11-01 Albert N. Santilli Vascular and intestinal occlusion
AU2006337171A1 (en) 2006-01-31 2007-08-09 Regents Of The University Of Minnesota Surgical support structure
US20090118747A1 (en) 2007-11-05 2009-05-07 Tyco Healthcare Group Lp Novel surgical fastener
US20100010520A1 (en) 2008-07-11 2010-01-14 Olympus Medical Systems Corp. Tissue fastener
WO2011066451A2 (fr) 2009-11-24 2011-06-03 Olsen Timothy W Structure de support de tissu

Patent Citations (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3927471A (en) * 1973-02-02 1975-12-23 Keith Arthur Tricker Electronic circuits
US4043564A (en) * 1974-05-28 1977-08-23 Garlock Inc. Pitman shaft boot seal
US4224934A (en) * 1979-04-11 1980-09-30 American Medical Systems, Inc. Medical prosthetic pull valve and system for using same
US20060039993A1 (en) * 1989-08-14 2006-02-23 Hughes Stephen E Retinal cell grafts and instrument for implanting
US20030054023A1 (en) * 1989-08-14 2003-03-20 Photogenesis, Inc. Volute subretinal implants
US6514238B1 (en) * 1989-08-14 2003-02-04 Photogenesis, Inc. Method for preparation and transplantation of volute grafts and surgical instrument therefor
US5817075A (en) * 1989-08-14 1998-10-06 Photogenesis, Inc. Method for preparation and transplantation of planar implants and surgical instrument therefor
US5962027A (en) * 1989-08-14 1999-10-05 Photogenesis, Inc. Retinal cell transplant
US6955809B2 (en) * 1989-08-14 2005-10-18 Photogenesis, Inc. Retinal cell grafts
US20030104618A1 (en) * 1989-08-14 2003-06-05 Central Institute For The Deaf Retinal cell grafts
US6045791A (en) * 1992-03-06 2000-04-04 Photogenesis, Inc. Retinal pigment epithelium transplantation
US5527356A (en) * 1994-08-02 1996-06-18 Syntec, Inc. Retinal plug
US6036678A (en) * 1995-02-28 2000-03-14 Photogenesis, Inc. Method for preparation and transplantation of planar implants and surgical instrument therefor
US5653752A (en) * 1995-02-28 1997-08-05 Keravision, Inc. Adjustable devices for corneal curvature adjustment
US5755716A (en) * 1996-08-30 1998-05-26 Garito; Jon C. Method for using an electrosurgical electrode for treating glaucoma
US6156042A (en) * 1997-11-17 2000-12-05 Aramant; Robert B. Retinal tissue implantation instrument
US6165042A (en) * 1998-11-10 2000-12-26 Chin; Lin-Chi Bob toy device
US20040039401A1 (en) * 2000-03-31 2004-02-26 Chow Alan Y. Implant instrument
US20030105456A1 (en) * 2001-12-04 2003-06-05 J.T. Lin Apparatus and methods for prevention of age-related macular degeneration and other eye diseases
US20060002900A1 (en) * 2002-10-04 2006-01-05 Susanne Binder Retinal pigment epithelial cell cultures on amniotic membrane and transplantation
US20040254567A1 (en) * 2003-02-12 2004-12-16 Holz Frank G. Surgical method for ablating tissue
US20060110428A1 (en) * 2004-07-02 2006-05-25 Eugene Dejuan Methods and devices for the treatment of ocular conditions

Cited By (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080074617A1 (en) * 2004-03-11 2008-03-27 Oti Ophthalmic Technologies Inc. Method and Apparatus for Displaying Oct Cross Sections
US7594730B2 (en) * 2004-03-11 2009-09-29 Oti Ophthalmic Technologies Inc. Method and apparatus for displaying OCT cross sections
US10278808B2 (en) 2006-01-31 2019-05-07 Emory University Surgical support structure
US11369374B2 (en) 2006-05-03 2022-06-28 Datascope Corp. Systems and methods of tissue closure
US10595861B2 (en) 2006-05-03 2020-03-24 Datascope Corp. Systems and methods of tissue closure
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
US11992211B2 (en) 2006-05-03 2024-05-28 Datascope Corp. Systems and methods of tissue closure
US8357158B2 (en) * 2008-04-22 2013-01-22 Covidien Lp Jaw closure detection system
US20090261804A1 (en) * 2008-04-22 2009-10-22 Tyco Healthcare Group Lp Jaw Closure Detection System
US10245104B2 (en) 2008-04-22 2019-04-02 Covidien Lp Jaw closure detection system
US11497547B2 (en) 2008-04-22 2022-11-15 Covidien Lp Jaw closure detection system
US20100298840A1 (en) * 2009-05-22 2010-11-25 Schwartz Lyman D Phimosis Treatment Device and Method
US9220585B2 (en) 2009-09-08 2015-12-29 Atrium Medical Corporation Hernia patch
US10603153B2 (en) 2009-09-08 2020-03-31 Atrium Medical Corporation Hernia patch
US20110144667A1 (en) * 2009-09-08 2011-06-16 Anthony Richard Horton Hernia patch
US8308715B2 (en) * 2009-11-13 2012-11-13 Circulite, Inc. Cannula stabilizer
WO2011059908A1 (fr) * 2009-11-13 2011-05-19 Circulite, Inc. Stabilisateur de canule
US20110118668A1 (en) * 2009-11-13 2011-05-19 Circulite, Inc. Cannula stabilizer
WO2011066451A3 (fr) * 2009-11-24 2011-10-13 Olsen Timothy W Structure de support de tissu
US9539082B2 (en) 2009-11-24 2017-01-10 Emory University Tissue support structure
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8679064B2 (en) 2009-12-23 2014-03-25 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
US9433725B2 (en) 2011-12-23 2016-09-06 Alcon Research, Ltd. Combined coaxial and bimanual irrigation/aspiration apparatus
US10039565B2 (en) 2012-12-13 2018-08-07 Alcon Research, Ltd. Fine membrane forceps with integral scraping feature
US9839738B2 (en) 2013-06-06 2017-12-12 Novartis Ag Transformer irrigation/aspiration device
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
US11564689B2 (en) 2013-11-19 2023-01-31 Datascope Corp. Fastener applicator with interlock
US10973682B2 (en) 2014-02-24 2021-04-13 Alcon Inc. Surgical instrument with adhesion optimized edge condition
US20160290377A1 (en) * 2015-04-06 2016-10-06 Koncept Technologies Inc. Telescoping joint
US10987119B2 (en) 2016-10-18 2021-04-27 Alcon Inc. Surgical instrument having a surface texture
US11653928B2 (en) 2018-03-28 2023-05-23 Datascope Corp. Device for atrial appendage exclusion

Also Published As

Publication number Publication date
AU2006337171A1 (en) 2007-08-09
EP1986581A1 (fr) 2008-11-05
EP1986581B1 (fr) 2012-10-03
US10278808B2 (en) 2019-05-07
US20150223929A1 (en) 2015-08-13
US20150018806A1 (en) 2015-01-15
WO2007089277A1 (fr) 2007-08-09

Similar Documents

Publication Publication Date Title
US10278808B2 (en) Surgical support structure
US11786402B2 (en) Glaucoma treatment device
JP6697777B2 (ja) 嚢切開装置
JP4303116B2 (ja) 眼科マイクロサージャリー装置
CN108697436B (zh) 眼科刀和使用方法
JP6253652B2 (ja) 調節可能フィラメントを伴う眼科外科手術用デバイス
US8672870B2 (en) Ocular implant with hydrogel expansion capabilities
US11166844B2 (en) Retinal patch graft and biopsy device
JP4872081B2 (ja) 硝子体手術用カニューラ
US20210000497A1 (en) Microsurgical Instruments For Concave Topologies
WO2006116732A2 (fr) Outil d'expansion de poche epitheliale et dispositif combine de decollement epithelial et de sculpture de la cornee

Legal Events

Date Code Title Description
AS Assignment

Owner name: REGENTS OF THE UNIVERSITY OF MINNESOTA, MINNESOTA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:OLSEN, TIMOTHY W.;LOFTNESS, PAUL E.;ERDMAN, ARTHUR G.;REEL/FRAME:018556/0653;SIGNING DATES FROM 20061027 TO 20061109

STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION