# US 8,123,729 B2 · Treatment of ocular disease

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- Number: US 8,123,729 B2
- Document ID: US8123729B2
- Status: Granted
- Kind: B2
- Application number: 12/587,375
- Filed: 2009-10-05
- Published: 2010-07-15
- Granted: 2012-02-28
- Earliest claimed: 1999-12-10
- Assignees: iScience Interventional Corporation
- Inventors: Ronald K. Yamamoto; Stanley R. Conston; Michael F. Nash; Paul S. Koch
- Web page: https://patentgrep.com/patent/US8123729B2

## CPC

- A61B 8/10: Eye inspection
- A61B 8/0841: {for locating instruments}
- A61F 9/00781: {Apparatus for modifying intraocular pressure, e.g. for glaucoma treatment (drainage implants in general A61M27/002)}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- 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 (dental prosthetics A61C)

## Abstract

The invention relates to a novel apparatus for the treatment of ocular disease, particularly glaucoma. The apparatus consists of a locating device to locate Schlemm's Canal within the anterior portion of the eye and a surgical tool to access the canal for treatment. The apparatus allows for guided, minimally invasive surgical access to Schlemm's Canal to enable surgical procedures to be performed on the canal and trabecular meshwork to reduce intraocular pressure. The apparatus may also deliver devices or substances to Schlemm's Canal in the treatment of glaucoma.

## Claims

### Claim 1

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an ultrasound imaging transducer; and
wherein the tissue contacting surface of the locating device is curved to approximate a curve of the exterior surface on an anterior of the patient's eye.

### Claim 2 (depends on 1)

The apparatus of claim 1, further comprising an image processing system and a display device for displaying an ultrasound image of the eye produced by the ultrasound imaging transducer of the locating device, the ultrasound image of the eye providing a visual indication of when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 3 (depends on 1)

The apparatus of claim 1, wherein the ultrasound imaging transducer operates at an ultrasound frequency of at least 10 MHz.

### Claim 4 (depends on 1)

The apparatus of claim 1, wherein the ultrasound imaging transducer operates at an ultrasound frequency of at least 40 MHz.

### Claim 5 (depends on 1)

The apparatus of claim 1, further comprising means to introduce an ultrasound contrast agent into the patient's aqueous humor.

### Claim 6 (depends on 1)

The apparatus of claim 1, wherein the locating device further comprises an audible or visible signal to indicate when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 7 (depends on 1)

The apparatus of claim 1, wherein the locating device further comprises a raised ridge around a periphery of the tissue contacting surface.

### Claim 8 (depends on 1)

The apparatus of claim 1, wherein the microsurgical device comprises a microcannula.

### Claim 9 (depends on 8)

The apparatus of claim 8, wherein the microcannula incorporates a cutting tip to penetrate a sclera of the eye.

### Claim 10

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the microsurgical device comprises a microcannula; and
wherein a distal portion of the microcannula is curved with a radius of approximately 12-14 mm to accommodate a curvature of Schlemm's Canal.

### Claim 11

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the microsurgical device comprises a microcannula; and
wherein the microcannula has an outer diameter of less than 200 microns.

### Claim 12 (depends on 11)

The apparatus of claim 11, wherein the locating device comprises an ultrasound imaging transducer.

### Claim 13 (depends on 12)

The apparatus of claim 12, wherein the tissue contacting surface of the locating means is curved to approximate a curve of the exterior surface on an anterior of the patient's eye.

### Claim 14 (depends on 12)

The apparatus of claim 12, wherein the tissue contacting surface of the locating device is curved to approximate a curve of the exterior surface on an anterior of the patient's eye.

### Claim 15 (depends on 14)

The apparatus of claim 14, wherein the locating device comprises an optical detector.

### Claim 16 (depends on 15)

The apparatus of claim 15, further comprising an image processing system and a display device for displaying an optical image of the eye produced by the optical detector of the locating device, the optical image of the eye providing a visual indication of when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 17 (depends on 15)

The apparatus of claim 15, wherein the locating device further comprises an audible or visible signal to indicate when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 18 (depends on 15)

The apparatus of claim 15, further comprising means to introduce to a fluorescent tracer into the patient's aqueous humor.

### Claim 19

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the microsurgical device comprises a microcannula; and
an inflatable dilating balloon mounted on a distal end of the microcannula.

### Claim 20

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device comprising a microcannula;
a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device; and
a device having an inflatable dilating balloon mounted on a distal end of the device, wherein the distal end of the device is configured for insertion through the microcannula.

### Claim 21

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm'Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device; and
an implant configured for implantation by the microsurgical device into Schlemm's Canal to maintain flow of aqueous humor.

### Claim 22 (depends on 21)

The apparatus of claim 21, wherein the implant comprises a stent.

### Claim 23 (depends on 22)

The apparatus of claim 22, wherein the stent comprises a biodegradable material.

### Claim 24 (depends on 21)

The apparatus of claim 21, wherein the implant comprises microparticles.

### Claim 25 (depends on 24)

The apparatus of claim 24, wherein the microparticles comprise a biodegradable material.

### Claim 26 (depends on 21)

The apparatus of claim 21, wherein the implant comprises microspheres.

### Claim 27 (depends on 26)

The apparatus of claim 26, wherein the microspheres comprise a biodegradable material.

### Claim 28 (depends on 21)

The apparatus of claim 21, wherein the implant comprises a drug releasing material.

### Claim 29 (depends on 28)

The apparatus of claim 28, wherein the drug releasing material contains a drug effective in the treatment of glaucoma.

### Claim 30 (depends on 21)

The apparatus of claim 21, wherein the microsurgical device comprises a microcannula slidably positioned within a guide sleeve.

### Claim 31

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an optical detector; and
wherein the optical detector comprises a high intensity white light illumination source.

### Claim 32

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an optical detector; and
wherein the optical detector comprises an optically coherent illumination source.

### Claim 33

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an optical detector; and
wherein the optical detector comprises a fiber optic device.

### Claim 34

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an optical detector; and
wherein the optical detector utilizes detection via visible wavelengths of light.

### Claim 35

An apparatus for treating ocular disease in a patient, the apparatus comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device;
wherein the locating device comprises an optical detector; and
wherein the optical detector utilizes detection via infrared wavelengths.

### Claim 36

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus;
wherein the tissue contacting surface of the locating device is curved to approximate a curve of the exterior surface on an anterior of the patient's eye.

### Claim 37 (depends on 36)

The apparatus of claim 36, wherein the locating device comprises an ultrasound imaging transducer.

### Claim 38 (depends on 37)

The apparatus of claim 37, further comprising an image processing system and a display device for displaying an ultrasound image of the eye produced by the ultrasound imaging transducer of the locating device, the ultrasound image of the eye providing a visual indication of when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 39 (depends on 37)

The apparatus of claim 37, wherein the ultrasound imaging transducer operates at an ultrasound frequency of at least 10 MHz.

### Claim 40 (depends on 37)

The apparatus of claim 37, wherein the ultrasound imaging transducer operates at an ultrasound frequency of at least 40 MHz.

### Claim 41 (depends on 37)

The apparatus of claim 37, further comprising means to introduce an ultrasound contrast agent into the patient's aqueous humor.

### Claim 42 (depends on 37)

The apparatus of claim 37, wherein the locating device further comprises an audible or visible signal to indicate when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 43 (depends on 36)

The apparatus of claim 36, wherein the locating device further comprises a raised ridge around a periphery of the tissue contacting surface.

### Claim 44 (depends on 36)

The apparatus of claim 36, wherein the microsurgical device comprises a microcannula.

### Claim 45 (depends on 44)

The apparatus of claim 44, wherein the microcannula incorporates a cutting tip to penetrate a sclera of the eye.

### Claim 46

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus;
wherein the microsurgical device comprises a microcannula; and
wherein a distal portion of the microcannula is curved with a radius of approximately 12-14 mm to accommodate a curvature of Schlemm's Canal.

### Claim 47

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus;
wherein the microsurgical device comprises a microcannula; and
wherein the microcannula has an outer diameter of less than 200 microns.

### Claim 48

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device comprising a microcannula;
a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus; and
an inflatable dilating balloon mounted on a distal end of the microcannula.

### Claim 49

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device comprising a microcannula;
a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus; and
a device having an inflatable dilating balloon mounted on a distal end of the device, wherein the distal end of the device is configured for insertion through the microcannula.

### Claim 50

An apparatus for treating ocular disease in a patient, comprising:
a handle, the handle having a longitudinal axis;
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device being coupled to the handle such that the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye and for indicating when Schlemm's Canal is located in a imaging plane that extends distally from the tissue contacting surface of the locating device;
a microsurgical device;
a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device being configured to access Schlemm's Canal within the imaging plane of the locating device and to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately perpendicular to the longitudinal axis of the handle of the apparatus; and
an implant configured for implantation by the microsurgical device into Schlemm's Canal to maintain flow of aqueous humor.

### Claim 51 (depends on 50)

The apparatus of claim 50, wherein the implant comprises a stent.

### Claim 52 (depends on 51)

The apparatus of claim 51, wherein the stent comprises a biodegradable material.

### Claim 53 (depends on 50)

The apparatus of claim 50, wherein the implant comprises microparticles.

### Claim 54 (depends on 53)

The apparatus of claim 53, wherein the microparticles comprise a biodegradable material.

### Claim 55 (depends on 50)

The apparatus of claim 50, wherein the implant comprises microspheres.

### Claim 56 (depends on 55)

The apparatus of claim 55, wherein the microspheres comprise a biodegradable material.

### Claim 57 (depends on 50)

The apparatus of claim 50, wherein the implant comprises a drug releasing material.

### Claim 58 (depends on 57)

The apparatus of claim 57, wherein the drug releasing material contains a drug effective in the treatment of glaucoma.

### Claim 59

An apparatus for treating ocular disease in a patient, comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device having a cantilever beam that extends axially with respect to the tissue contacting surface of the locating device, a guiding sleeve coupled to the cantilever beam, an angle adjustment mechanism for adjusting an angle of the guiding sleeve with respect to the tissue contacting surface of the locating device and a mechanism for advancing the microsurgical device through the guiding sleeve and into Schlemm's Canal within the patient's eye
wherein the microsurgical device comprises a microcannula slidably positioned within the guide sleeve; and
wherein the mechanism for advancing the microsurgical device through the guiding sleeve and into Schlemm's Canal within the patient's eye comprises a thumbwheel configured to engage a lead screw connected to the microcannula.

### Claim 60 (depends on 59)

The apparatus of claim 59, wherein the surgical access device is configured to deliver the microsurgical device into Schlemm's Canal along a path spaced apart distally from the tissue contacting surface of the locating device and approximately parallel to the tissue contacting surface of the locating device.

### Claim 61 (depends on 59)

The apparatus of claim 59, further comprising a handle having a longitudinal axis, wherein the tissue contacting surface is approximately perpendicular to the longitudinal axis of the handle, and wherein the surgical access device is configured to deliver the microsurgical device into Schlemm's Canal along a path approximately perpendicular to the longitudinal axis of the handle.

### Claim 62 (depends on 59)

The apparatus of claim 59, wherein the locating device comprises an ultrasound imaging transducer, and wherein the apparatus further comprises an image processing system and a display device for displaying an ultrasound image of the eye produced by the ultrasound imaging transducer of the locating device, the ultrasound image of the eye providing a visual indication of when Schlemm's Canal is located in the imaging plane of the locating device distal to the tissue contacting surface of the locating device.

### Claim 63

An apparatus for treating ocular disease in a patient, comprising:
a locating device, the locating device having a tissue contacting surface configured for contacting an exterior surface of the patient's eye, the locating device adapted for non-invasively locating Schlemm's Canal within the patient's eye;
a microsurgical device;
and a surgical access device physically coupled to the locating device for guiding the microsurgical device in relation to the locating device, the surgical access device having a cantilever beam that extends axially with respect to the tissue contacting surface of the locating device, a guiding sleeve coupled to the cantilever beam, an angle adjustment mechanism for adjusting an angle of the guiding sleeve with respect to the tissue contacting surface of the locating device and a mechanism for advancing the microsurgical device through the guiding sleeve and into Schlemm's Canal within the patient's eye;
wherein the microsurgical device comprises a microcannula slidably positioned within the guide sleeve and an inflatable dilating balloon mounted on a distal end of the microcannula.

### Claim 64 (depends on 63)

The apparatus of claim 63, wherein the mechanism for advancing the microsurgical device through the guiding sleeve and into Schlemm's Canal within the patient's eye comprises a thumbwheel configured to engage a lead screw connected to the microcannula.