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
  • 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
  • A61F9/0008—Introducing ophthalmic products into the ocular cavity or retaining products therein
  • A61F9/0017—Introducing ophthalmic products into the ocular cavity or retaining products therein implantable in, or in contact with, the eye, e.g. ocular inserts
• • 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
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
  • A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body

Definitions

• the present invention generally pertains to the delivery of ophthalmically
• the present invention pertains to apparatus and methods for sub-Tenon delivery of a drug depot to the posterior segment of a human eye
• Age related macular degeneration AMD
• choroidal neovascularization AMD
• CNV retinopathies
• retinopathys e.g., diabetic retinopathy, vitreoretinopathy
• retinitis e.g., cytomegalovirus (CMV) retinitis
• uveitis macular edema
• glaucoma retinopathies
• CMV cytomegalovirus
• Age related macular degeneration is the leading cause of blindness in the elderly. ARMD attacks the center of vision and blurs it, making reading, driving, and other detailed tasks difficult or impossible. About 200,000 new cases of ARMD
• wet ARMD is the type of ARMD that most often causes blindness. In wet ARMD, newly formed choroidal blood vessels (choroidal neovascularization (CNV)) leak fluid and cause progressive damage to the retina.
• CNV choroidal neovascularization
• Such movement may cause penetration of the Tenon's capsule, allowing drug to be injected into surrounding tissues. Furthermore, such movement may also cause inadvertent penetration of the sclera, resulting in injection of drug into the vitreous
• a hub 201 a straight proximal portion 202, and an angled distal portion 204 to
• Quadrant Sub-Tenon's Bock Evaluation of a New Local Anaesthetic Technique for Eye Surgery", Anaesthesia and Intensive Care 24: 241-244, April 1996.
• cannulae also suffer from the above-described "tenting" and penetration problems if used to deliver drugs into the sub-Tenon's space above the macula.
• the straight portion includes a curved distal portion that is disposed at a 90 degree angle to the straight portion to inject a local anesthetic solution below the Tenon's capsule.
• the curved portion has a length of 5 mm.
• the curved portion has a radius of curvature of 14 mm and an
• One aspect of the present invention comprises a cannula including a distal portion having a radius of curvature substantially equal to a radius of curvature of a
• a tangent of the distal portion at the bend is disposed at an angle of no more than about 56 degrees with respect to the proximal portion.
• the present invention comprises a method of delivering a drug to the human eye.
• a cannula is inserted below the Tenon's capsule and above the sclera of the human eye at a point posterior to a limbus of the eye.
• the cannula includes a distal portion having a radius of curvature substantially equal to a radius of
• a drug is injected through the cannula to form a drug depot on an outer surface of the sclera.
• the drug comprises a
• pharmaceutically active agent selected from the group consisting of 4,9(11)-
• the present invention comprises a cannula including a hub
• the distal portion has a tip, an orifice proximate the tip, and a radius of curvature
• the part of the distal portion proximate the tip comprises a plastic.
• FIG. 1 is a side sectional view schematically illustrating the human eye and a drug depot according to a preferred embodiment of the present invention
• FIG. 2 is a side, partially sectional view schematically illustrating a cannula for
• FIGS. 3A through 3E are side views schematically illustrating additional preferred embodiments of the cannula of FIG. 2;
• FIG. 4 is a side view schematically illustrating a preferred embodiment of the cannula of FIG. 2 having dual lumens
• FIG. 5 is a side view schematically illustrating a second preferred embodiment of the cannula of FIG. 2 having dual lumens
• FIG. 6 is a side view schematically illustrating a first conventional cannula
• FIG. 7 is a side view schematically illustrating a second conventional cannula. Detailed Description of the Preferred Embodiments
• FIGS. 1 through 5 of the drawings like numerals being used for like and corresponding parts of the various drawings.
• FIG. 1 schematically illustrates a human eye 10.
• Eye 10 has a cornea 12, a lens 14, a lens 16, a lens 16, a lens 18, a lens 20, a lens, and a lens 16.
• An anterior segment 24 of eye 10 generally includes the portions of eye 10 anterior of line 25.
• posterior segment 26 of eye 10 generally includes the portions of eye 10 posterior of
• Retina 20 is physically attached to choroid 18 in a circumferential manner proximate pars plana 28. Retina 20 has a macula 30 located slightly lateral to optic
• a Tenon's capsule or Tenon's membrane 34 is disposed on sclera 16.
• a conjunctiva 36 covers a short area of the globe of eye 10 posterior to limbus 32 (the bulbar conjunctiva) and folds up (the upper cul-de-sac) or down (the lower cul-de-sac) to cover the inner areas of upper eyelid 35 and lower eyelid 37, respectively.
• Conjunctiva 36 is disposed on top of Tenon's capsule 34.
• Sclera 16 and Tenon's capsule 34 define the exterior surface of the globe of
• a depot 38 of a specific quantity of an oph halmically acceptable pharmaceutically active agent is preferable to dispose a specific quantity of an oph halmically acceptable pharmaceutically active agent directly on the outer surface
• an angiostatic steroid available from Steraloids, Inc. of Wilton, New Hampshire, was disposed directly on the outer surface of the sclera, below the
• a concentration of the angiostatic steroid resulted in a concentration of the angiostatic steroid, averaged over the entire retina and measured the day after the injection, about ten times greater than a similar concentration delivered by a depot located below the conjunctiva but above the
• Cannula 50 for creating drug depot 38 is schematically illustrated.
• Cannula 50 generally includes a distal portion 52, a proximal portion 54, and a hub 56.
• a hollow bore 58 runs axially
• Distal portion 52 preferably has a blunt tip 62 to prevent damage to blood vessels in the periocular tissues and to pass smoothly over sclera 16.
• An orifice 64 is
• Orifice 64 is preferably located about 1 mm from tip 62 on the lower or interior side of distal portion 52 to
• Orifice 64 may alternatively be located on the end, on the upper or exterior side, or on other portions of distal portion 52.
• distal portion 52 may have multiple orifices, if desired.
• Orifice 64 is
• orifice 64 preferably circular and preferably has a 0.025 inch diameter that insures a smooth, controlled delivery of drug.
• orifice 64 may be any shape and sizes.
• Distal portion 52 and proximal portion 54 are preferably formed out of 19
• gauge needle stock is a gauge needle stock.
• other sizes of tubing may be utilized depending on the
• portion 54 are preferably made of surgical stainless steel.
• Teflon other metals, metal alloys, polyethylene, polypropylene,
• distal portion 52 may be made from a plastic.
• a part of distal portion 52 proximate tip 62 may be made from plastic, and the remainder of distal portion 52 and proximal portion 54 may be made from metal.
• the plastic preferably has sufficient softness and/or flexibility to minimize the possibility of penetration of sclera 16 or Tenon's capsule 34 when cannula 50 is inserted into eye 10, as described hereinbelow.
• the length of the plastic portion of distal portion 52, as well as the specific plastic are preferably selected so that distal portion
• Hub 56 is for removably coupling to a conventional syringe (not shown). Hub
• Hub 56 preferably complies with Luer Taper Specification 70.1 of the American Standards Association.
• Hub 56 preferably includes a locator protuberance 66 that is coplanar with distal portion 52 and proximal portion 54. Protuberance 66 allows a physician to
• Hub 56 is preferably made of conventional plastics.
• distal portion 52 preferably has an arc length A and a radius of curvature B that closely approximate the curvature of sclera 16 of an
• Arc length A and radius of curvature B insure that drug depot 38, and more specifically, a specific quantity of pharmaceutically active agent, is deposited on the outer surface of sclera 16 generally above macula 30. Arc length A and bend 57 also limit the depth of insertion of cannula 50 along
• arc length A is
• Arc length A may be varied for patient's
• a tangent 72 of distal portion 52 at bend 57 is preferably formed at an angle C with respect to proximal portion 54.
• angle C also raises the angle of hub 56 so that the face, bridge of the nose, and eyebrows of a patient to not interfere with the attached syringe.
• Angle C is also
• Angle C is preferably no more than about 56 degrees.
• Proximal portion 54 is most preferably about 56 degrees.
• Proximal portion 54 preferably has a length D of about 15 mm. Other angles and lengths may be used for angle C and length D for specific applications of cannula 50.
• Radius of curvature B insures that distal portion 52 does not drag or put
• radius of curvature B eliminates the "tenting" or pulling away of Tenon's capsule 34 from sclera 16, minimizing the risk of penetration into the periocular tissues.
• radius of curvature B For an adult human eye 10 and for superior temporal or inferior temporal sub-Tenon insertion of cannula 50, radius of curvature B
• Radius of curvature B may be varied for patients with smaller or larger than average
• Cannula 50 may be used to inject a wide variety of drug formulations using the
• a physician first anesthetizes eye 10 using conventional topical anesthetic drops. The patient is then
• the physician uses a 25 gage, 5/8 inch needle to penetrate both conjunctiva 36 and Tenon's capsule 34 at a point about 4 mm posterior to limbus 32 in the superior temporal quadrant of eye 10.
• the needle is then advanced along the outer surface of sclera 16 to a point about 8 mm to about 9 mm posterior of limbus 32.
• the physician then makes a small bleb of anesthesia, preferably about 1 mm to about 2 mm long, at this point.
• the physician uses a 25 gage, 5/8 inch needle to penetrate both conjunctiva 36 and Tenon's capsule 34 at a point about 4 mm posterior to limbus 32 in the superior temporal quadrant of eye 10.
• the needle is then advanced along the outer surface of sclera 16 to a point about 8 mm to about 9 mm posterior of limbus 32.
• the physician then makes a small bleb of anesthesia, preferably about 1 mm to about 2 mm long, at this point.
• introducer needle preferably has an outer diameter with the same gage as cannula 50 or one gage larger than cannula 50.
• cannula 50 so that the drug formulation is at tip 62.
• the physician then introduces cannula 50 through the hole made by the introducer needle, with orifice 64 facing sclera 16. With distal portion 52 in close contact with the outer surface of sclera 16,
• cannula 50 is advanced toward the back of the eye until bend 57 is at the site of the hole made by the introducer needle.
• tip 62 is preferably located about 5 mm to about 6 mm from the center of optic nerve 22, and about 2 mm to about 3 mm
• the above-described technique may be performed in the inferior temporal quadrant of eye 10, in which case the patient is instructed to look
• a physician first anesthetizes eye 10 using
• cannula 50 is advanced toward the back of the eye until bend 57 is at the site of the incision.
• tip 62 is preferably located about 5 mm to
• the incision may be sealed around cannula 50 using a purse
• suture to prevent reflux of the injected drug formulation may be performed in the inferior temporal quadrant of eye 10, in which case the patient is instructed to look up and toward his or her nose.
• depot 38 preferably provides controlled release of a pharmaceutically active agent to macula 30 and retina 20 via sclera 16 and choroid 18 for a period of weeks or months.
• cannula 50 causes no "tenting" or substantial stretching of Tenon's
• cannula 50 should result in significantly less trauma to eye 10 than conventional cannulae when repeated injections are required.
• Cannula 50 can be used to deliver a wide variety of drug formulations to treat
• drug depot 38 may be a solution, a suspension, an emulsion, an ointment, a gel
• drug formulation used to form drug depot 38 may include one or more ophthalmically acceptable pharmaceutically active agents, and may also include conventional non- active incipients.
• pharmaceutically active agents suitable for this drug formulation are anti-infectives, including, without limitation, antibiotics, antivirals,
• antiallergenic agents and mast cell stabilizers include steroidal and non- steroidal anti-inflammatory agents; cyclooxygenase inhibitors, including, without limitation, Cox I and Cox II inhibitors; combinations of anti-infective and anti- inflammatory agents; decongestants; anti-glaucoma agents, including, without
• adrenergics ⁇ -adrenergic blocking agents, ⁇ -adrenergic agonists, parasypathomimetic agents, cholinesterase inhibitors, carbonic anhydrase inhibitors, and prostaglandins
• combinations of anti-glaucoma agents including, without limitation, non-steroidal anti-inflammatory agents
• drugs for the treatment of ARMD include, without limitation, non-steroidal anti-inflammatory agents, drugs for the treatment of ARMD,
• angiogenesis inhibitors and nutritional supplements including, without limitation, angiogenesis inhibitors and nutritional supplements; drugs for the treatment of herpetic infections and CMV ocular infections; drugs for the treatment of proliferative vitreoretinopathy including, without limitation,
• wound modulating agents including, without
• growth factors including growth factors; antimetabolites; neuroprotective drugs, including, without limitation, eliprodil; and angiostatic steroids for the treatment of diseases or conditions of posterior segment 26, including, without limitation, ARMD, CNV,
• retinopathies retinitis, uveitis, macular edema, and glaucoma.
• angiostatic steroids are more fully disclosed in U.S. Patent Nos. 5,679,666 and 5,770,592.
• Preferred ones of such angiostatic steroids include 4,9(1 l)-Pregnadien-17 ⁇ ,21-diol-
• preferred angiostatic steroids are preferably formulated as a suspension.
• a preferred angiostatic steroids are preferably formulated as a suspension.
• non-steroidal anti-inflammatory for the treatment of cystoid macular edema is nepafenac.
• the conventional non-active excipients may include, but are not limited to, ingredients to enhance the stability, solubility, penetrability, or other properties of the pharmaceutically active agent or drug depot 38.
• FIGS. 3 A through 3E show additional preferred embodiments of cannulae for the creation of drug depot 38.
• Each of these cannulae have a proximal portion 54, hub
• each of these cannulae has a unique distal portion.
• Hub 56 of each of these cannulae is removably coupled to a conventional syringe 80.
• Each of these cannulae can be used to create drug depot 38 directly on the outer surface of sclera 16 generally above macula 30 in a manner substantially similar to the techniques described above for cannula 50.
• Cannula 82 of FIG. 3 A has a distal portion 52a with a geometry substantially identical to distal portion 52 of cannula 50, except that an orifice 64a is located on the end of tip 62 of distal portion 52a.
• cannula 84 of FIG. 3B has a distal
• portion 52b with a geometry substantially identical to distal portion 52 of cannula 50, except that tip 62 has two orifices, 64 and 64b. Orifice 64b is located on the upper or exterior side of distal portion 52b. Alternatively, although not shown in FIG. 3B,
• orifices 64 and 64b may be located laterally, on opposite sides of distal portion 52b.
• Cannula 86 of FIG. 3C has a distal portion 52c with a geometry substantially identical to distal portion 52 of cannula 50, except that a plurality of orifices 64c, 64d,
• 64e, and 64f are disposed on distal portion 52c proximate tip 62. Orifices 64c through
• 64f are preferably disposed on distal portion 52c in the alternating pattern shown in
• FIG. 3C Cannula 86 is useful when it is desirable to create a larger drug depot 38.
• Distal portion 52c may be formed with more or less than the four orifices shown in
• Cannula 88 of FIG. 3D has a distal portion 52d with a geometry substantially identical to distal portion 52a of cannula 82 of FIG. 3 A, except that tip 62d has a globular or olive shape.
• Tip 62 thus serves as a scleral depressor, allowing a physician to view tip 62d through an ophthalmoscope as he or she guides cannula 88 along the outer surface of sclera 16.
• Tip 62 is preferably sized to create as small a pathway as possible between Tenon's capsule 34 and sclera 16, but still function as a scleral depressor. A small pathway minimizes the possibility of drug formulation
• Cannula 90 of FIG. 3E has a distal portion 52e with a geometry substantially identical to distal portion 52 of cannula 50 of FIG. 2, except that tip 62e is also
• a conventional power source 94 is electrically coupled to fiber optic light source 92 via conventional electrical wiring 96 that is preferably at least partially
• Fiber optic light source 92, power source 94, and wiring 96 may be incorporated into any of the cannulae disclosed in this application, if desired.
• FIG. 4 schematically illustrates a preferred embodiment of a cannula 100 for
• Cannula 100 includes a lumen 102 having a geometry
• Cannula 100 also includes a second, separate lumen 104 disposed adjacent to lumen 102 and having a geometry substantially identical to cannula 82 of FIG. 3 A.
• Lumen 102 has a hub 56 removably
• Lumen 104 has a hub 56
• Cannula 100 can be used to create drug depot 38 directly on the outer surface of sclera 16 generally above macula 30 in a manner substantially similar to the
• cannula 100 allows the delivery of two separate drug formulations while creating drug depot 38.
• lumen 104 of cannula 100 can be used to aspirate a non-bioerodable drug depot 38 that has dispensed all of its pharmaceutically active agent, and lumen 102 of cannula 100 can be used to inject a new drug depot 38.
• FIG. 5 schematically illustrates a preferred embodiment of a cannula 120 for
• Cannula 120 has a geometry substantially identical to that of cannula 100, except that lumen 102 and lumen 104 j oin at a point 122 proximate a single orifice 64f near the distal portions of the cannula.
• Cannula 120 can be used to create drug depot 38 directly on the outer surface of sclera 16 generally above macula 30 in a manner substantially similar to the techniques described above for cannula 50. However, cannula 120 allows the delivery of two separate formulations that require mixing just prior to injection out of orifice
• the present invention provides improved apparatus and methods for sub-Tenon delivery of a drug depot to the posterior segment of a human eye proximate the macula.
• the apparatus and methods of the present invention provide improved apparatus and methods for sub-Tenon delivery of a drug depot to the posterior segment of a human eye proximate the macula.
• present invention increase patient safety, are easy for the physician to use, are capable of delivering a wide spectrum of formulations, and are capable of being performed in
• the apparatus and methods of the present invention are especially useful for localized delivery of pharmaceutically active agents to the
• the apparatus and methods of the present invention are also particularly useful for the sub-Tenon
• the cannulae can be used to deliver drugs directly on the outer surface of the sclera
• the arc length and/or radius of curvature of the distal portions of the cannulae may be modified to deliver drugs within the Tenon's capsule
• the sclera generally above the macula or other portions of the retina, if desired.

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• Health & Medical Sciences (AREA)
• Ophthalmology & Optometry (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Vascular Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Infusion, Injection, And Reservoir Apparatuses (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicinal Preparation (AREA)
• Prostheses (AREA)

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• 2000
  • 2000-10-04 PT PT00968673T patent/PT1221918E/pt unknown
  • 2000-10-04 CA CA002383572A patent/CA2383572C/en not_active Expired - Fee Related
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  • 2000-10-04 EP EP00968673A patent/EP1221918B1/en not_active Expired - Lifetime
  • 2000-10-04 EP EP05100176A patent/EP1522289A3/en not_active Withdrawn
  • 2000-10-04 JP JP2001531070A patent/JP2003511204A/ja active Pending
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  • 2000-10-18 AR ARP000105478A patent/AR026075A1/es active IP Right Grant
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