Methods of transverse placement in elt

Abstract

Glaucoma patients suffer from increased intraocular pressure due to blocked fluid flow from the anterior chamber of the eye. Methods of the invention include inserting a probe into an eye of a subject having glaucoma, adjusting placement of the probe to a position transverse to Schlemm's canal in the eye, and applying a plurality of shots from an excimer laser source while the probe is in the transverse position, thereby treating glaucoma by creating a plurality of perforations in Schlemm's canal and/or the trabecular meshwork. By providing a laser probe at a position transverse to Schlemm's canal, energy from the laser is delivered to a greater amount of surface area than if the laser was arranged in a parallel or perpendicular position to Schlemm's canal, resulting in optimal formation of perforations. The perforations allow for drainage of fluid and increased outflow of aqueous humor in the eye.

1 - 15 . (canceled) 
     
     
         16 . An apparatus for delivering laser energy to a surface of a trabecular meshwork of an eye to treat glaucoma comprising:
 an excimer laser source;   a probe configured to connect to the excimer laser source; and   a delivery tip connected to the probe, wherein:
 the probe is configured to be inserted into an eye of a subject having glaucoma; 
 the delivery tip of the probe is shaped to be placed at a position transverse to Schlemm's canal in the eye; 
 the probe is further configured to deliver a plurality of shots of energy from an excimer laser source to create a plurality of perforations having transverse placement in the trabecular meshwork relative to the Schlemm's canal of the eye, wherein the plurality of perforations are created in the trabecular meshwork in order to treat the glaucoma. 
   
     
     
         17 . The apparatus of  claim 16 , wherein a light source aids in placement of the delivery tip of the probe. 
     
     
         18 . The apparatus of  claim 17 , wherein the light source is a Gonio lens, endoscope, or other illumination source. 
     
     
         19 . The apparatus of  claim 16 , wherein the plurality of shots comprises 10 shots per eye. 
     
     
         20 . The apparatus of  claim 16 , wherein the plurality of shots comprises greater than 10 shots per eye. 
     
     
         21 . The apparatus of  claim 16 , wherein each perforation has a diameter of 200 μm. 
     
     
         22 . The apparatus of  claim 16 , wherein the probe is configured to be inserted into an incision in the eye. 
     
     
         23 . The apparatus of  claim 22 , wherein the incision has a length of about ⅛ inch or smaller. 
     
     
         24 . The apparatus of  claim 16 , further the probe is further configured to cause, upon application of the plurality of shots, visually observable drainage of aqueous humor and bloody reflux. 
     
     
         25 . The apparatus of  claim 16 , wherein the probe is a fiber probe. 
     
     
         26 . The apparatus of  claim 26 , wherein the delivery tip of the fiber probe comprises an optical fiber jacketed in a metal. 
     
     
         27 . The apparatus of  claim 26 , wherein the metal is stainless steel. 
     
     
         28 . The apparatus of  claim 26 , wherein the delivery tip is beveled. 
     
     
         29 . The apparatus of  claim 16 , wherein the excimer laser source comprises a xenon chloride laser. 
     
     
         30 . The apparatus of  claim 16 , wherein the delivery tip is further configured to physically contact the trabecular meshwork, wherein the plurality of perforations are created while the delivery tip is physically contacting the trabecular meshwork. 
     
     
         31 . The apparatus of  claim 16 , wherein at least one of the plurality of perforations creates a fluid path from a front chamber of the eye through the trabecular meshwork to the Schlemm's canal. 
     
     
         32 . The apparatus of  claim 16 , wherein the probe is further configured to be removed from the eye after the plurality of perforations are created. 
     
     
         33 . An apparatus for delivering laser energy to a surface of a trabecular meshwork of an eye to treat glaucoma comprising:
 a probe, wherein:
 the probe is configured to be inserted into an eye of a subject having glaucoma; 
 a delivery tip of the probe is shaped to be placed at a position transverse to Schlemm's canal in the eye; 
 the delivery tip is configured to physically contact the trabecular meshwork with the probe; and 
 the probe is further configured to deliver a plurality of shots of energy from an excimer laser source to create a plurality of perforations having transverse placement in the trabecular meshwork relative to the Schlemm's canal of the eye, wherein the plurality of perforations are created in the trabecular meshwork in order to treat the glaucoma. 
   
     
     
         34 . The apparatus of  claim 33 , wherein at least one of the plurality of perforations creates a fluid path from a front chamber of the eye through the trabecular meshwork to the Schlemm's canal. 
     
     
         35 . The apparatus of  claim 33 , wherein the plurality of perforations are created while the delivery tip is physically contacting the trabecular meshwork. 
     
     
         36 . A method of delivering laser energy to a surface of a trabecular meshwork of an eye to treat glaucoma comprising:
 inserting a probe into an eye of a subject having glaucoma;   adjusting placement of the probe to a position adjacent to Schlemm's canal in the eye; and   creating a plurality of perforations having transverse placement in the trabecular meshwork relative to the Schlemm's canal of the eye by applying a plurality of shots from an excimer laser source, wherein the plurality of perforations are created in the trabecular meshwork in order to treat the glaucoma.   
     
     
         37 . The method of  claim 36 , further comprising moving the placement of the probe in a pattern transverse to the Schlemm's canal to create the plurality of perforations.