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WO2006039096A2 - Dispositif de pose de stents lacrymaux - Google Patents

Dispositif de pose de stents lacrymaux Download PDF

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Publication number
WO2006039096A2
WO2006039096A2 PCT/US2005/032594 US2005032594W WO2006039096A2 WO 2006039096 A2 WO2006039096 A2 WO 2006039096A2 US 2005032594 W US2005032594 W US 2005032594W WO 2006039096 A2 WO2006039096 A2 WO 2006039096A2
Authority
WO
WIPO (PCT)
Prior art keywords
probe
distal end
tapered
puncta
guide
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.)
Ceased
Application number
PCT/US2005/032594
Other languages
English (en)
Other versions
WO2006039096A3 (fr
Inventor
Jeremy S. Melker
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 Florida
University of Florida Research Foundation Inc
Original Assignee
University of Florida
University of Florida Research Foundation Inc
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 University of Florida, University of Florida Research Foundation Inc filed Critical University of Florida
Publication of WO2006039096A2 publication Critical patent/WO2006039096A2/fr
Publication of WO2006039096A3 publication Critical patent/WO2006039096A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

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
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00772—Apparatus for restoration of tear ducts

Definitions

  • the present invention relates to the field of lacrimal stents, devices for manipulation of such stents, and novel methods in the area of inserting small stents.
  • Lacrimal fluid or tears are continuously supplied from the lacrimal gland located laterally and superiorly of the eye through the upper lacrimal duct to the conjunctival sac in which the eyeball is partially encased.
  • the lacrimal fluid washes across the sclera and other conjunctival components and also the cornea.
  • the lacrimal apparatus consists of a series of ducts which allow the natural drainage of lubricating tears from the eyes into the nasal cavity.
  • Upper and lower lid punctae located near the medial aspect of the lids, lead to lacrimal canaliculi. These, in turn, drain to the lacrimal sac, which then becomes confluent with the nasolacrimal duct, the ultimate pathway by which tears reach the nasal cavity.
  • a permanent closure occurs in the canaliculi, the lacrimal sac, or the nasolacrimal duct, whereupon the lacrimal fluid no longer can be disposed of in the normal maimer resulting in chronic tearing (epiphora).
  • epiphora chronic tearing
  • Such closure or stenosis can result from congenital anomalies, following surgical manipulation of the eye or surrounding structures, accident, inflammation or other disease, or advancing age.
  • the canaliculi may become scarred from conjunctival infection.
  • Epiphora likewise can result from blockage of the canaliculi by a cilium or by streptothrix concretions. In severe cases permanent stenosis occurs and a dacryocystorhinostomy is indicated.
  • Lacrimal duct stenting is commonly performed as a portion of surgical procedures in which the lacrimal apparatus is violated.
  • the goal of stent placement is to prevent scarring of drainage pathways, thereby avoiding the complication of epiphora.
  • stents may be placed for congenital malformations of the lacrimal apparatus, or when the apparatus has been disrupted as the result of trauma.
  • the subject invention is directed to novel system and methods for inserting lacrimal stents.
  • the subject system faciliatates easy insertion of both small and large stents, while minimizing injury to the lacrimal apparatus and orbit.
  • One object of the invention is to provide a novel tapered probe to assist in the placement of a guidewire into the puncta and canaliculi of the patient in need.
  • the novel tapered probe is preferably cannulated so that a guidewire can be passed through the cannula.
  • the novel tapered probe comprises a cannula that passes from the tip of the tapered probe to a sideport on the tapered probe.
  • Another object of the invention pertains to a novel flexible, blunt-tipped probe that is cannulated.
  • the cannula passes from the tip of the flexible, blunt-tipped probe to a sideport defined thereon.
  • a further object of the invention pertains to a kit comprising a cannulated, rigid, tapered probe and a flexible, blunt-tipped probe.
  • the kit may include silastic tubing for insertion and use as a lacrimal stent.
  • the cannulated, rigid, tapered probe and flexible, blunt-tipped probe of the kit preferably comprise a channel defined within which span from the tip of the probes to a site on the side of the probes, sideport.
  • Yet another object of the subject invention is directed to a novel method for placement of a lacrimal stent that comprises insertion of a rigid tapered dilator probe in the puncta.
  • a second tapered probe comprising a central lumen leading to a sideport is placed in the puncta.
  • a blunt-ended guidewire is passed through the sideport, through the lumen, and out the tip of the second tapered probe. The guidewire is guided safely into the puncta and directed into the canaliculi.
  • the second tapered probe is removed.
  • a blunt-tipped, flexible probe having a central lumen and sideport is obtained.
  • the guidewire is positioned through the tip, through the lumen, and out the sideport of the flexible probe.
  • Figure 1 shows a side view of prior art blunt-tipped, flexible probes, Figure IA, and prior art rigid tapered dilators, Figure IB-C.
  • Figure 2 shows a side view of one embodiment of the subject invention.
  • Figure 2A shows a rigid tapered dilator comprising a channel defined from its tip to a location on its side.
  • Figure 2B shows a blunt-tipped flexible probe comprising a channel defined from its tip to a location on its side.
  • Figure 3 shows a diagram of a preferred method embodiment of the subject invention.
  • Figure 4 shows a view of the lacrimal apparatus, Figure 4A, and shows a stent embodiment positioned in the upper and lower punctae Figure 4B.
  • Figure 1 shows examples of blunt-tipped flexible probes (Figure IA, commonly known as “Crawford Probes”) and rigid tapered dilators (Figure IB and C) that are currently used for inserting lacrimal stents in patients with a need for such stents.
  • the probes and dilators shown in Figure 1 represent just a few examples of current devices that may be modified according to the teachings herein to achieve probes and dilators for use with the subject methods. See www.fci-opthalmics.com; U.S. Patent Nos.
  • probes, stents, and related devices may include a channel that spans from one end, preferably tip end, of the device to a side port, or through the opposite end, wherein a guidewire may pass through the channel to assist the physician in guiding a stent into the lacrimal apparatus, as taught herein.
  • Figure 2 shows a dilator 204 and probe 202 comprising a channel 210, 211, respectively, that spans from the tip 212, 213, respectively, of the dilator 204 or probe 202 to a sideport 214, 215, respectively.
  • lacrimal insertion instruments in addition to those shown in Figure 1, may be modified to include a channel comprising the features of the channel illustrated in Figure 2, i.e., extending from the tip of the instrument to a sideport.
  • the dilator or analogous instrument may be fully cannulated from one end of the instrument to the other.
  • Figure 3A-F represents a stepwise diagram of a preferred embodiment of the subject methods for inserting a lacrimal stent.
  • Figure 3 shows the insertion of a rigid tapered dilator 302, such as that shown in Figure 2A, into the puncta 304 of a patient.
  • a guidewire 306 is passed through the channel 308 of the dilator 302. The guidewire 306 is inserted to the appropriate depth; and the dilator 302 is then removed from the canaliculi 303 and puncta 304, whereby the guidewire 306 remains in place.
  • a blunt-tipped, flexible probe 310 such as that shown in Figure 2B, is passed over the guidewire 306 and into the puncta 304.
  • the guidewire 306 assists the physician in guiding the probe 310 into the puncta 304.
  • the guidewire 306 is passed out of the probe 310.
  • the probe 310 is then advanced through canaliculi and appropriate duct(s) in conventional fashion.
  • Figure 4A illustrates the anatomy of a portion of the lacrimal apparatus including the upper 410 and lower 412 punctae, upper 414 and lower 416 canaliculi, and the lacrimal sac 418.
  • Figure 4B illustrates the stent 420 in place after the ends have been inserted through the upper and lower punctae, probes cut, and ends tied together in the nasal cavity.
  • the lacrimal apparatus consists of a series of ducts which allow the natural drainage of lubricating tears from the eyes into the nasal cavity (see attached diagram).
  • Upper and lower Hd punctae located near the medial aspect of the lids) lead to lacrimal canaliculi. These, in turn, drain to the lacrimal sac, which then becomes confluent with the nasolacrimal duct, the ultimate pathway by which tears reach the nasal cavity.
  • Lacrimal duct stenting is commonly performed as a portion of surgical procedures in which the lacrimal apparatus is violated.
  • the goal of stent placement is to prevent scarring of drainage pathways, thereby avoiding the complication of epiphora (excessive tear leakage down the face).
  • stents may be placed for congenital malformations of the lacrimal apparatus, or when the apparatus has been disrupted as the result of trauma.
  • the insertion of a first rigid dilator to form an opening of sufficient size in the puncta is necessary before attempting to insert the cannulated tapered probe. Due to the opening of the distal end of the tapered dilator probe, the distal end may not provide a sufficiently fine point to insert into a small puncta opening, hi an alternate embodiment, as shown in FIG. 5a-b, the tapered dilator probe 204 with the central channel 210 is used from the beginning of the procedure, avoiding the need for a rigid dilator probe to expand the puncta, even for those with small openings.
  • a semi-rigid, pre-fitted, tapered tip guide 500 that is initially seated within the central channel 210.
  • the tapered tip 512 of the tapered tip guide 500 widens to smoothly match the taper of the tapered dilator probe 204 at its tip 212.
  • a stop 510 along the shaft of the guide maintains its appropriate position within the tapered probe with the central lumen during initial probing of the puncta.

Landscapes

  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Plastic & Reconstructive Surgery (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)
  • Prostheses (AREA)

Abstract

Système d'introduction de stents lacrymaux à l'aide d'une sonde rigide effilée et d'une sonde souple à pointe émoussée, les deux sondes fournissant un passage destiné à diriger un fil de guidage. Le fil de guidage aide à positionner de manière efficace les stents lacrymaux, tout en réduisant à un minimum les lésions possibles des structures de l'appareil lacrymal.
PCT/US2005/032594 2004-09-30 2005-09-14 Dispositif de pose de stents lacrymaux Ceased WO2006039096A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US61474804P 2004-09-30 2004-09-30
US60/614,748 2004-09-30

Publications (2)

Publication Number Publication Date
WO2006039096A2 true WO2006039096A2 (fr) 2006-04-13
WO2006039096A3 WO2006039096A3 (fr) 2006-08-24

Family

ID=36142961

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2005/032594 Ceased WO2006039096A2 (fr) 2004-09-30 2005-09-14 Dispositif de pose de stents lacrymaux

Country Status (1)

Country Link
WO (1) WO2006039096A2 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008056060A3 (fr) * 2006-11-08 2008-08-21 Bruno Fayet Ensemble d'intubation monocanaliculonasal et/ou monocanaliculaire, notamment pour l'imperforation lacrymonasale
FR2916345A1 (fr) * 2007-05-22 2008-11-28 Optisoins Sa Dispositif pour le traitement du larmoiement de l'oeil
WO2011049198A1 (fr) * 2009-10-22 2011-04-28 株式会社カネカ Dispositif à tubes destiné à être inséré dans une voie lacrymale
CN107647952A (zh) * 2017-11-06 2018-02-02 江西瑞济生物工程技术股份有限公司 一种羊膜泪道修复支架及其制造方法
CN114432033A (zh) * 2020-11-02 2022-05-06 医诺共赢(北京)管理科技有限公司 一种一次性使用泪道引流管及其使用方法
CN116687660A (zh) * 2022-03-03 2023-09-05 浦易(上海)生物技术股份有限公司 一种可降解泪道植入物
RU231866U1 (ru) * 2024-12-09 2025-02-14 Государственное бюджетное учреждение здравоохранения города Москвы "Научно-исследовательский клинический институт оториноларингологии им. Л.И. Свержевского" Департамента здравоохранения города Москвы Зонд-проводник для слёзоотводящих путей

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6113567A (en) * 1995-10-25 2000-09-05 Becker; Bruce B. Lacrimal silicone tube with reduced friction

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008056060A3 (fr) * 2006-11-08 2008-08-21 Bruno Fayet Ensemble d'intubation monocanaliculonasal et/ou monocanaliculaire, notamment pour l'imperforation lacrymonasale
US8192389B2 (en) 2006-11-08 2012-06-05 Bruno Fayet Monocanaliculonasal and/or monocanalicular intubation assembly, mainly for nasolachrymal imperforation
FR2916345A1 (fr) * 2007-05-22 2008-11-28 Optisoins Sa Dispositif pour le traitement du larmoiement de l'oeil
WO2009004140A3 (fr) * 2007-05-22 2009-03-19 Optisoins Sa Dispositif pour le traitement du larmoiement de l'oeil
WO2011049198A1 (fr) * 2009-10-22 2011-04-28 株式会社カネカ Dispositif à tubes destiné à être inséré dans une voie lacrymale
CN107647952A (zh) * 2017-11-06 2018-02-02 江西瑞济生物工程技术股份有限公司 一种羊膜泪道修复支架及其制造方法
CN107647952B (zh) * 2017-11-06 2019-10-18 江西瑞济生物工程技术股份有限公司 一种羊膜泪道修复支架及其制造方法
CN114432033A (zh) * 2020-11-02 2022-05-06 医诺共赢(北京)管理科技有限公司 一种一次性使用泪道引流管及其使用方法
CN116687660A (zh) * 2022-03-03 2023-09-05 浦易(上海)生物技术股份有限公司 一种可降解泪道植入物
RU231866U1 (ru) * 2024-12-09 2025-02-14 Государственное бюджетное учреждение здравоохранения города Москвы "Научно-исследовательский клинический институт оториноларингологии им. Л.И. Свержевского" Департамента здравоохранения города Москвы Зонд-проводник для слёзоотводящих путей

Also Published As

Publication number Publication date
WO2006039096A3 (fr) 2006-08-24

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