as best seen in fig3 - 5 , the non - penetrating deep sclerectomy / canalostomy surgical procedure involved with implant 10 of the present invention involves creating a scleral cavity or pocket into which implant 10 is placed . initially , superficial scleral flap 100 is formed in eye 200 . flap 100 is generally less than one - third of the scleral thick and can extend up to two millimeters into the clear cornea . flap 100 may be generally 5 millimeters by 6 millimeters but can be made larger or smaller depending upon factors such as the size of the eye or the desired size of implant 10 . the sclera is further dissected to remove deep portion of sclera 110 to expose descemet &# 39 ; s membrane 130 leaving a thin layer of deep sclera over the choroid posteriorly . anteriorly , the dissection is done reaching schlemm &# 39 ; s canal 120 ( which is unroofed ) and continuing further into corneal stromal tissue to the level of descemet &# 39 ; s membrane 130 . the removal of the inner endothelium of schlemm &# 39 ; s canal 120 and juxta - canalicular trabecula can also be performed at this stage using a fine forceps ( not shown ). the aqueous percolation into the achieved scleral cavity will thus be established . deep scleral portion 110 can be of any size suitable to allow for implantation of implant 10 , but generally will be approximately 4 millimeters by 5 millimeters , but can be made larger or smaller depending upon factors such as the size of the eye or the size of flap 100 . as best seen in fig1 - 2 , implant 10 of the present invention is designed to be implanted within a void formed in the sclera during non - penetrating deep sclerectomy / canalostomy surgery by the removal of deep sclera portion 110 and includes body 12 and tubular elements 14 . implant 10 preferably is made in multiple components from any suitable biocompatible material , such as polymethylmethacrylate ( pmma ), polycarbonate , polyurethane , polyamide , polypropylene , silicone , soft acrylic , hydrogel , stainless steel or titanium . implant 10 may be coated with any suitable coating to enhance biocompatibility or to help prevent implant 10 from fouling or become clogging with fibrotic growth , such as heparin , mytomycin , 5 - fu or other suitable coatings well - known in the art . body 12 is generally flat or slightly curved to approximate the curvature of the sclera and contains sidewalls 16 that form hollow interior 18 . body 12 may be of any suitable size and shape , such as rectangular , semi - circular or elliptical and between 4 millimeter and 5 millimeters across , but can be made larger or smaller depending upon factors such as the size of the eye or the size of deep scleral portion 110 . body 12 may contain port 17 that communicates with hollow interior 18 . sidewalls 16 preferably are between 100 microns and 200 microns tall . tubes 14 may have tapered ends 15 and preferably are sized and shaped to fit snugly within the openings in the unexcised portions of schlemm &# 39 ; s canal and contains bores 20 that communicate with hollow interior 18 . tubes 14 may be made adjustable to address the need of variable and unpredictable anatomical location of schlemm &# 39 ; s canal 120 from patient to patient . implant 10 may also contain bottom plate 50 having a similar construction as body 12 and containing a circumferential groove 52 sized and shaped so as to allow plate 50 to securely fit onto and be held by sidewalls 16 on body 12 . plate 50 has outwardly tapering fitting 54 having a port 56 that communicates with hollow interior 18 of body 12 when plate 50 is attached to body 12 . in use during non - penetrating deep sclerectomy / canalostomy surgery , void 140 is created in the sclera that exposes descemet &# 39 ; s membrane 130 and schlemm &# 39 ; s canal 120 in the manner described above . body 12 is place in void 140 so that sidewalls 16 lay perpendicularly to descemet &# 39 ; s membrane 130 and hollow interior 18 is exposed to descemet &# 39 ; s membrane 130 . if desired , body 12 may be filled with a viscoelastic substance , such substances being well - known in the art , to help minimize fibrotic adhesions . in addition , the viscoelastic agent may contain a antimetabolite , such as mytomycin or 5 - fu . tapered ends 15 of tubular elements 14 are inserted into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 . if desired , the openings in the unexcised portions of schlemm &# 39 ; s canal 120 may be enlarged slightly by the introduction of a viscoelastic substance , such substances being well - known in the art in order to facilitate the introduction of tapered ends 15 into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 . flap 100 is placed over implant 100 and sutured in place . port 17 in body 12 normally will be sealed by plug 19 so that any fluid entering hollow interior 18 will be contained within body 12 . in this manner , aqueous fluid may percolate through descemet &# 39 ; s membrane 130 and enter the openings in the unexcised portions of schlemm &# 39 ; s canal 120 through hollow interior 18 , ports 20 in tubular arms 15 . in the event that schlemm &# 39 ; s canal 120 can not be found and / or tubes 14 can not be placed in the openings in the unexcised portions of schlemm &# 39 ; s canal 120 , flap 100 will be not tightly closed and plug 19 may be removed from body 12 thus allowing passage through port 17 , causing subconjunctival outflow with bleb formation similar to the deep sclerectomy surgery . if inadequate bleb formation occurs , then flap 100 may be opened and plug 19 may be removed from port 17 and replaced with piercing plug 21 and flap 100 replaced . alternatively , even with successful placement of tubes 14 into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 , in the event that outflow from interior 18 through ports 20 and into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 becomes blocked or is insufficient to reduce intraocular pressure a sufficient amount , flap 100 may be opened and plug 19 may be removed from port 17 and replaced with piercing plug 21 and flap 100 replaced . plug 21 allows excess aqueous fluid to exit interior 18 through flap 100 and into the subconjunctival space between the scleral and conjunctiva , thereby forming a subconjunctival bleb . in the event that percolation through descemet &# 39 ; s membrane 130 is insufficient to relieve the excess intraocular pressure , plate 50 may be used by attaching plate 50 to body 12 and placing the combination of body 12 and plate 50 in void 140 so that fitting 54 punctures descemet &# 39 ; s membrane 130 and projects downwardly into the anterior chamber of eye 200 . port 56 allows for more positive drainage of aqueous fluid from the anterior chamber into hollow interior 18 and out through ports 20 into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 . in the event that outflow from interior 18 through ports 20 and into the openings in the unexcised portions of schlemm &# 39 ; s canal 120 becomes blocked or is insufficient to reduce intraocular pressure a sufficient amount , plug 19 may be removed from port 17 and replaced with plug 21 . plug 21 allows excess aqueous fluid to exit interior 18 through flap 100 and into the subconjunctival space between the scleral and conjunctiva , thereby forming a subconjunctival bleb . this description is given for purposes of illustration and explanation . it will be apparent to those skilled in the relevant art that changes and modifications may be made to the invention described above without departing from its scope or spirit .
an implant system which facilitates and improves the non - penetrating deep sclerectomy / canalostomy surgery by assured maintenance of the scleral aqueous filled space by a basic permanent chamber which can be easily connected into the opening of the schlemm &# 39 ; s canal by adjustable connecting tubes . this implant system also provides surgical options for penetrating through descemet &# 39 ; s membrane as well as for outflow into the subconjunctival space though the superficial scleral layer .