HK1164683A - Implant for inserting into the schlemm's canal of an eye - Google Patents

Description

Implant for insertion into the schlemm's canal of the eye

The invention relates to an implant for insertion into the Schlemm's canal of an eye exposed by an incision and a turned-up sclera, comprising an elongated, thin tube which is flexibly inserted in at least one quarter of the circumference into the lumen of the annular Schlemm's canal and which has a plurality of openings arranged at a distance from one another.

Ophthalmic background

In a healthy eye, aqueous humor (interstitial fluid) circulating from the posterior chamber to the anterior chamber drains at the ventricular angle (horny iris angle) through the trabecular meshwork into the schlemm's canal, from where it is carried into the circulation through the episcleral venous system. When the eye is diseased, especially when resistance may be created by obstruction of the schlemm's canal by adhesions, the continuous drainage of aqueous humor, which is produced by the epithelium of the ciliary body and constantly renewed, cannot be adequately ensured. As a result, intraocular pressure (IOP) may rise to affect the blood circulation of the optic nerve, thereby causing a decrease in its function, which is identified as an ocular disease and is known as glaucoma, possibly leading to complete blindness of the affected eye.

Prior Art

In order to improve and maintain the anatomical drainage of aqueous humor, european patent publications EP0898947a2 and EP1125568a2 disclose thin tubes or thin tubular meshes or similarly shaped supports provided with openings which can be inserted into or removed from schlemm's canal after exposing it through an incision and a turned-up sclera and injecting a highly viscous substance. With the elongated support member, it is believed that a natural anatomical drainage of circulating and constantly renewing aqueous humor from the anterior chamber through the trabecular tissue into the lumen of schlemm's canal, from where it enters the blood circulation through the episcleral venous system.

Furthermore, U.S. patent publication US2004/0210181A1 discloses a T-shaped implant attachable to a blade and insertable through an incision in the sclera, comprising a proximal tube insertable effectively directly into the anterior chamber or through trabecular tissue, and two distal tubes oriented opposite each other for insertion into the exposed Schlemm's canal. The implant is configured to direct a constantly renewed aqueous humor drainage from a proximal tube inserted into the anterior chamber through a distal tube directly into the schlemm's canal and thence through the episcleral venous system into the blood circulation of the eye when pathological occlusion of the trabecular tissue occurs, thereby avoiding elevated intraocular pressure (IOP).

U.S. patent publication Nos. 2005/0192527A1 and 2007/0088432A1 also disclose implants for treating cataract that are either configured to have thermal or mechanical shape memory and can be made to approximate a T-shape, or are configured to be generally T-shaped without shape memory. These implants are insertable into the anterior chamber through a proximal tube, either directly or through effectively trabecular tissue, and into schlemm's canal through two oppositely oriented distal tubes disposed at the proximal tube, so that continuously renewed aqueous humor can likewise be delivered directly from the anterior chamber into schlemm's canal through the artificial channel and from there into the blood circulation of the eye through the episcleral venous system.

To reduce the internal pressure, WO2008/002377a1 also discloses an implant comprising a plurality of supports provided with a circular surface and arranged in rows on an elongated wire or similar structure, which is inserted through a scleral incision and placed in the lumen of an exposed annular schlemm's canal, for example along the entire circumference or as a single circular flexible member, by means of a correspondingly formed device.

In the generally known method of tube angioplasty, it is also possible to perform circumferential expansion by expanding the schlemm's canal into a circular shape by means of inserted flexible microcatheters, at the same time as or after which the viscoelastic polymer substance is injected by means of so-called microsporks. Thereafter, the microcatheter is removed using a suitable means, such as a surgical thread, and the annular schlemm's canal is extended toward the anterior chamber to allow the trabecular tissue to be dilated and increased flow is achieved with good drainage of aqueous humor through the trabecular.

Disclosure of Invention

It is an object of the present invention to provide an implant insertable into schlemm's canal through which aqueous humor circulation regulating the intraocular pressure throughout the annular lumen of schlemm's canal is achieved, improving and permanently maintaining aqueous humor drainage through the episcleral venous system into the eye.

The implant according to the preamble of claim 1 of the invention is characterized in that the elongated tubule comprises two connection portions oriented in axial direction and arranged diametrically opposite each other on the circumferential surface, a number of separator ring members arranged axially spaced apart from each other and openings between the ring members, which openings are connected to the interior of the tube and arranged opposite each other on the tubule circumferential surface between the first and second connection portions, each opening being provided with an opening angle oriented in circumferential direction.

The embodiments and scope and details of the invention are clearly shown in the following description and drawings and the various claims.

An advantage of the implant according to the invention is that the schlemm's canal is thus permanently opened and kept stable when inserted into the schlemm's canal lumen. The implant extends circumferentially along at least half of the circumference, preferably the entire circumference of the canal of Schlemm, so that it can be held open over the entire circumference to achieve the anatomically natural drainage of aqueous humor through the episcleral venous system into the blood circulation via the trabecular meshwork, and thus the regulation of intraocular pressure (IOP).

To optimize the drainage of aqueous humor through the trabeculae, the implant according to the present invention may be inserted and placed within the enlarged lumen of the schlemm's canal after the canal has been circumferentially expanded.

Drawings

The drawings of the following specification respectively show:

fig. 1 is a longitudinal section of an eye shown schematically in enlargement;

FIG. 2 is a schematic front view showing a parabolic incision in the sclera and an unfolded scleral piece;

FIG. 3 is a portion of the eye shown enlarged along plane A-A in FIG. 2, showing schlemm's canal partially exposed;

FIG. 4 is a portion of an eye shown enlarged with an injection probe inserted into Schlemm's canal;

FIG. 5 is an enlarged view of a portion of the exposed Schlemm's canal according to FIG. 4, showing the implant inserted and placed in the cavity;

FIG. 6 is a front view of a first embodiment of an implant made from a circular or elliptical tube;

FIG. 7 is a cross-sectional view of the annular ring implant shown in enlargement along the plane B-B in FIG. 6;

FIG. 8 is an enlarged view of a variation of the implant having an oval cross-section along the plane B-B in FIG. 6;

FIG. 9 is a front view of a second embodiment of an implant made from a circular or oval elongated tube;

FIG. 10 is an enlarged view of the implant body having a circular cross-section taken along plane C-C of FIG. 9;

FIG. 11 is a variant of an implant with a circular cross-section according to FIG. 10;

FIG. 12 is an enlarged view of a variation of the implant having an oval cross-section along the plane C-C of FIG. 9;

FIGS. 13-16 are other embodiments of implants having an elliptical cross-section along the plane C-C of FIG. 9; and

fig. 17-18 illustrate additional variations of the implant shown in fig. 6.

Detailed Description

It is noted here that only a portion of the eye is shown in fig. 1-5 to better understand the problems associated with cataract surgery. Further, the same components in each drawing are assigned the same reference numerals throughout the following description.

Fig. 1 shows the front part of an eye 10, which has been disclosed in a view of patent publication EP0898947, in which the cornea 10, the iris 12 with two regions 12 ' and 12 ", the sclera 13, the lens 14 with the pupil 14 ', the zonular fibres 19, the schlemm's canal 15 in the form of a ring (schlemm's canal), and the trabecular tissue 18 (trabecular corneoscleral) located in front of the schlemm's canal 15 are shown.

As shown in FIG. 1, in a healthy eye, the circulating and constantly renewed aqueous humor (interstitial fluid) from the posterior chamber H to the anterior chamber V according to arrows 1, 1 ' and 2, 2 ' is drained in the region of the angle of the chamber (angular iridocorneal) in the direction of arrow 3, through trabecular tissue 18 into the lumen of the annular Schlemm's canal 15, where it then enters the blood circulation again through the episcleral venous system (not shown in FIG. 1).

As previously mentioned, in the case of eye disease, a continuous drainage of aqueous humor, produced and constantly renewed by the epithelial tissue of the ciliary body, cannot be achieved. Schlemm's canal 15 may close in such a way that drainage of aqueous humor is hindered or even substantially stopped, so that the intraocular pressure rises to such an extent that blood circulation in the optic nerve is reduced, as a result of which such a limited function leads to blindness.

Fig. 2 is a schematic front view of an eye 10, also disclosed in patent publication EP0898947, comprising a lens 14 with a pupil 14 ', a part of a sclera 13, a part of schlemm's canal 15 and a part of a duct system 20, 20 '(aqueous humor channel system) communicating with schlemm's canal. The schematically partially shown schlemm's canal 15 extends circumferentially over an angle of 360 deg. and annularly around the lens 14.

A thin layer cut is made on the sclera 13 by microsurgery, after separation of a portion of the sclera (the details of which are not shown here), the outer layer portion 13' of the scleral piece is turned over and held there by means not shown here in detail, ready for further operation. The thin incision in the region of the exposed schlemm's canal 15 forms the scleral bed 17, which scleral bed 17 is closed again after a subsequent operation, such as insertion and placement of an elongated implant, by lowering the part 13' (scleral plate) in the direction of arrow 23.

In other variants of microsurgery, trabecular tissue 18 (fig. 3) located in front of schlemm's canal 15 may be at least partially ring-dissected by means of a cutting instrument (not shown here) which has been inserted into the anterior chamber V for insertion and placement of the implant.

Fig. 3 is an enlarged view of a portion of an eye 10 along line a-a in fig. 2, including a cornea 11, a first region 12 'of an iris 12, a sclera 13 with a scleral disc 13', a lens 14, zonular fibers 19, a posterior chamber H, an anterior chamber V with a chamber angle V ', trabecular tissue 18, schlemm's canal 15 with an implant 35 placed therein. As shown schematically and in greater detail in fig. 3, schlemm's canal 15 extends generally along trabecular tissue 18 and has a cross-sectional profile that resembles an elongated ellipse that tapers substantially from one end of the region of chamber angle V' to the other. Furthermore, fig. 3 shows a scleral bed 17 formed by cutting and an inner surface 17 ″ having a support surface 17 'for the scleral plate 13'.

Fig. 4 shows how a tubular stylet 33 located on the connector 32 is inserted into the lumen 16 of the exposed schlemm's tube 15 in the prior art. The connection 32 is connected to the schematically shown injection device 30 by a supply line (not shown). By means of the injection device 30 and a tubular probe 33 having at least one outlet 33 'at the distal end, for example a hydrophilic liquid 29 can be injected into schlemm's canal 15 in the direction of arrow 31, thereby expanding a section 15 'of schlemm's canal 15 in the circumferential direction by means of hydraulic pressure.

Furthermore, schlemm's tube 15 can be expanded in a known manner by means of a probe arranged in a mirror image and inserted into the section 15 "of schlemm's tube 15 opposite the section 15 ' that has been treated, so as to perform a hydraulic expansion in the circumferential direction. Fig. 4 also shows trabecular tissue 18 (trabecular meshwork) with a schematically shown tissue network 18 'in front of schlemm's canal 15 and a catheter system 20 with small channels 21, 22.

During the aforementioned dilation of schlemm's canal 15, the opening in the inner wall (not shown) can optionally be simultaneously filled with a hydrophilic liquid 29 which will adhere in the form of a film to the inner wall of the opening, thus preventing local tissue adhesion and thus allowing drainage of aqueous humor. Instead of using a hydrophilic liquid, a suitable biocompatible gaseous medium may be used or a mixture of a hydrophilic liquid and a gaseous medium may be used to effect expansion of schlemm's canal.

As shown schematically in figure 5, after hydraulic or pneumatic expansion, the implant 35 is inserted into the lumen 16 of the annular Schlemm's canal 15 to optimize the permanent permeability and circulation of the aqueous humor. The implant 35 comprises a flexible tubule 36, preferably made of a biocompatible flexible material, which is inserted into the lumen 16 of the schlemm's canal 15 by means of a suitable device (not shown in detail here) such as a stylet (insertion instrument) or the like.

Fig. 5 also shows a length of implant 35 inserted into schlemm's canal 15 and detachably placed at the proximal end (the end closest to the insertion instrument) of the probe (insertion instrument). At the other, distal end (the end furthest from the insertion instrument), the implant 35 includes an opening 35f with an abutment ring 37 that abuts the inner side 13 "of the sclera 13. The implant 35, which is inserted into the lumen 16 of the Schlemm's canal 15, extends at least one quarter, one half, three quarters or preferably the entire circumference from one inner side 13 ' of the exposed Schlemm's canal 15 (not shown in detail) to the opposite inner side (fig. 2). In one variation (not shown), a generally semicircular implant 35 may be inserted in the exposed schlemm's canal 15 from both one side of the lamina incision and from the opposite side. The lumen 16 of the annular schlemm's canal 15 is supported and kept open by the implant 35.

Fig. 5 also shows a scleral bed 17 formed through a thin incision between two inner sides 13 "opposite each other, forming a lower sclera or aqueous humor collection pool when the scleral piece is laid down and supported by a parabolic support surface 17' and sutured to the sclera 13. The scleral bed 17 communicates with the interior space 35e through two mutually opposed openings 35f (only one of the openings 35f is shown in the drawing) of the implant 35.

Fig. 5 also shows a section of the implant 35 inserted into schlemm's canal 15 abutting against the inner wall 16 ' of the lumen 16 and supporting the inner wall 16 ' by means of spaced apart ring members 35 c. The openings or recesses 35a between the ring members 35c each form a direct and permanently open connection between the trabecular tissue and the respective small channels 21 'and 22' of the catheter system 20 'as shown in fig. 5, thereby achieving a natural trabecular drainage of aqueous humor from the anterior chamber V through the trabecular tissue 18 into the annular schlemm's canal 15 or into the interior 35e of the implant 35 and from there through the episcleral venous system into the blood circulation.

Figure 6 shows a first embodiment of an implant made of a pliant tubule 36 comprising two circumferentially disposed connecting portions 35b opposite each other and extending along a longitudinal axis Z and a ring member 35c disposed along the longitudinal axis Z and spaced apart from each other. Between the ring members 35c are openings 35a that communicate to the interior space 35e of the implant 35. In the illustrated embodiment, the opening 35a leading to the interior space 35e is square, however, the opening 35a may be any shape, such as oval, elliptical, square, or trapezoidal.

It should be noted in this connection that the openings 35a and the spacer-like ring members 35c located therebetween (as shown in fig. 17) may be arranged inclined in one direction or in the other with respect to the longitudinal axis Z, wherein each ring member 35c is parallel to and spaced apart from each other. The ring members 35c including the openings 35a provided therebetween may be alternately and oppositely obliquely arranged with respect to the longitudinal axis Z. As shown in fig. 18, the opening 35a provided in series on one side of the narrow tube 36 and the opening 35 a' provided in series on the other side of the narrow tube 36 facing each other are also arranged offset from each other in the direction of the longitudinal axis Z.

The diaphragm-like ring member 35c is preferably relatively narrow, while the axially-oriented opening 35a or recess 35a is relatively large, so that when the implant 35 is inserted as previously described, the trabecular tissue 18 and each of the small passages 21 ', 22 ' of the catheter system 20 ' are exposed, enabling natural trabecular flow of aqueous humor (fig. 5).

Fig. 7 shows an enlarged implant body 35 with a circular cross-sectional contour along the line B-B in fig. 6 and with two connecting portions 35B which are arranged circumferentially opposite one another and are oriented in the direction of the longitudinal axis Z. Further, the illustrated opening 35a is circumferentially disposed between the connecting portions 35b and communicates to the internal space 35 e. In the present embodiment, the opening angle W of the openings 35a opposed to each other between the respective diaphragm-like ring members 35c ranges between 90 and 105. The connecting portion 35b has an annular surface 35b 'oriented in the direction of the longitudinal axis Z and is provided as a support for the inner wall 16' of the inner chamber 16 (fig. 5).

Figure 8 shows an enlarged view of a variant of the implant 35 along the section line B-B in figure 6. Unlike the embodiment shown in fig. 7, the implant 35 has an oval cross-section, preferably configured as a double-symmetrical circular ellipse having two symmetry axes X and Y orthogonal to the longitudinal axis Z. The implant 35, which is configured as a double-symmetrical circular ellipse, has two connecting portions 35b at the smaller circular ends, the connecting portions 35b being oriented in the longitudinal direction and having an arcuate outer surface 35 b'. Fig. 8 also shows the openings 35a, which are situated on the larger annular side and opposite one another, which lead to the interior space 35e, which in the present embodiment have opening angles W each in the range from 90 ° to 105 °.

Fig. 9 shows another embodiment of an implant made of a flexible tubule 36, which, unlike the embodiment shown in fig. 6, comprises only one continuous connection 35b oriented in the direction of the longitudinal axis Z and a plurality of ring members 35c separated by openings 35 a. In the present embodiment, each opening 35a is a notch extending from one side to the other side of the connecting portion 35 b. The distance D between the individual spacer-like ring members 35c is chosen such that when the implant 35 has a circular arc shape (not shown), the edges K of the spacer-like ring members 35c remain spaced apart from each other. As a result, the implant 35 inserted into the schlemm's canal 15 assumes a balanced position oriented in the circumferential direction, and the respective ring members 35c can be prevented from tilting. Each of the ring members 35c arranged in the direction of the longitudinal axis Z and spaced apart from each other forms an arc-shaped surface 35 b' on the outside similarly to the connecting portion 35 b. The ring members 35c shown in fig. 9 spaced parallel to each other may be arranged to be inclined in either direction in the axial direction or alternately inclined in opposite directions to each other.

Fig. 10 shows, in a circular cross-sectional view along section line C-C of fig. 9, an implant body 35 having a connecting portion 35b oriented in the direction of the longitudinal axis Z with an arc-shaped surface 35 b' and a recess 35a with an opening angle W of 280-290 deg. and communicating to the inner space 35 e.

Figure 11 shows a further variant of the implant 35 in a cross-sectional view along the sectional line C-C in figure 9, wherein each ring member 35C of the annular implant 35 is interrupted by axially oriented slots 35d on opposite sides of the connecting portion 35 b. Each ring 35c, which can be detachably connected to, for example, a probe (insertion instrument) or the like, is bent upward relative to each other and will return to its original position due to its own elastic restoring force of the spring.

Fig. 12 shows a further variant of the implant 35 in an enlarged sectional view along the sectional line C-C in fig. 9. Unlike the embodiment shown in fig. 10 and 11, the implant 35 shown in fig. 12 has an elliptical cross-sectional shape, preferably a double-symmetrical circular ellipse having a longitudinal axis Z and two axes of symmetry X and Y arranged substantially orthogonal to the longitudinal axis Z. In this variant, a connection 35b having an arc-shaped surface 35 b' and oriented along the longitudinal axis Z is provided in the upper part of the ellipse. However, in another modification (not shown), the connecting portions 35b may be provided to opposite lower arc portions of the ellipse.

Fig. 13 shows a variant of the implant 35 according to fig. 12, in which the ring members 35c arranged at a distance from one another and oriented in the direction of the longitudinal axis Z are each separated by a slot 35d at the end of the ellipse opposite the connecting portion 35 b. Thus, each ring member can be bent upwards (not shown in detail herein) relative to each other and returned to its original position by its own elastic restoring force of the spring.

Fig. 14 shows another embodiment of an implant 35 with an oval cross-section, which is preferably configured as a double symmetrical circular oval with a longitudinal axis Z and two axes of symmetry X and Y. In the present implant 35, the connecting portion 35b having the curved outer surface 35 b' is oriented in the longitudinal axis Z direction and may be provided on one curved side or the opposite curved side.

Fig. 15 shows a variant of the implant according to fig. 14, in which the ring members 35c arranged at a distance from one another in the direction of the longitudinal axis Z are each separated at their smaller arc-shaped ends of the ellipse by a slot 35 d. Of course, the slot 35d may also be provided at the other, opposite arcuate end of the ellipse.

Fig. 16 shows a further variant of the implant 35, in which, in contrast to the version shown in fig. 15, the ring members 35c arranged at a distance from one another in the direction of the longitudinal axis Z on the connecting portion 35b are each separated by a slot 35d arranged in any position of the ellipse in the circumferential direction.

With respect to the implants shown in figures 13, 15 and 16, the ring members 35c, separated by the slots 35d, can be bent upwards about the axis X, for example for detachable connection to a probe (insertion instrument), and can be returned to their initial position by their own elastic restoring force of the spring.

The slots 35a between the diaphragm-like ring members 35c of the implant 35 arranged in a double symmetrical circular ellipse in fig. 12 to 16 are each provided with an opening angle W of 280 to 290 ° in the circumferential direction of the ellipse.

The implant 35, which is made from the elongated tube shown and described in connection with fig. 6-18, may be made from a biocompatible flexible material such as gold, nitinol, or a biocompatible flexible material such as a polymer material having a thermal shape memory function or a mechanical shape memory function. Thus, for example, an implant 35 configured to approximate the shape of the circular schlemm's canal 15 is largely bent upward and may be inserted into schlemm's canal 15 at room temperature of about 18-22 ℃ prior to insertion, while it remains against the inner wall 16 'in a shape corresponding to schlemm's canal 15 and can return to its original shape due to a body temperature of about 35-37 ℃. The implant 35 may also be slightly compressed in a direction perpendicular to the longitudinal axis at room temperature of about 18 c-22 c (not shown in detail herein) prior to or during insertion of the schlemm's canal 15, and the implant 35 will return to its original circular or oval shape due to a body temperature of about 35 c-37 c.

Furthermore, the implant 35 made of flexible material may also comprise two axially opposite connecting portions 35b (fig. 7 and 8), or only one axially positioned connecting portion 35b (fig. 10-16). In a preferred embodiment, a heparin coating may also be provided on the implant 35 made of the elongated tube 36 that is configured in a circular or elliptical shape.

In order to insert the implant 35 into the lumen 16 of the schlemm's canal 15, according to the previously described method of angioplasty, the schlemm's canal is carefully dilated circumferentially and at the same time or afterwards a high-molecular elastic-viscous substance is injected by means of so-called micro-screws. After expansion, the microcatheter is removed, whereupon Schlemm's canal 15 is pulled slightly toward anterior chamber V, thereby stretching trabecular tissue 18 for insertion of implant 35. With the annular flexible implant according to the invention described in detail above and shown in fig. 6-18, on the one hand, the trabecular tissue is continuously dilated and, on the other hand, the inner lumen 16 of the annular schlemm's canal 15 remains circumferentially open and stable at all times, for drainage of aqueous humor through the trabeculae.

Claims (21)

1. An implant for insertion into the Schlemm's canal (15) of an eye (10) exposed through an incision and a turned-up scleral segment (13'), comprising an elongated tubule (36) which is inserted into the lumen (16) of the Schlemm's canal (15) with a curvature of at least one quarter of its circumference and which has a plurality of openings arranged at a distance from one another, characterized in that the elongated tubule (36) has two connecting portions (35b) oriented in the axial direction and arranged diametrically opposite each other on the circumferential surface, a plurality of spacer-like ring members (35c) arranged axially at a distance from each other, and a plurality of openings (35a) arranged between the respective opposing ring members (35c) and communicating with the inner space (35e) of the tubule (36), the openings are arranged on the circumferential surface of the narrow tube (36) so as to face each other between the first and second connection sections (35b) and each have an opening angle (W) oriented in the circumferential direction.

2. Implant according to claim 1, characterised in that the openings (35a) provided on the circumference of the tubule (36) between the first and second connecting portions (35b) and between the ring members (35c) arranged at a distance from each other are each provided with an opening angle (W) of 90 ° -105 °.

3. Implant according to claim 1, characterised in that the openings (35a) provided on the circumferential surface of the tubule (36) between the first and second connecting portions (35b) and between the respective ring members (35c) arranged at a distance from one another are each formed as circumferentially oriented recesses (35 a).

4. Implant according to claim 3, characterised in that the recesses (35a) provided on the circumference of the tubule (36) each have an opening angle (W) of 280-290 °.

5. Implant according to claim 1, characterised in that the second connection (35b), opposite the first connection (35b), is provided with a continuous axially oriented slit-like slot (35d), the two part-portions being distractable relative to each other.

6. Implant according to claim 1, characterised in that the separator-plate-like ring elements (35c) arranged axially at a distance from each other on the first connecting portion (35b) are each provided with a slot-like slot (35d), the two partial portions being expandable relative to each other.

7. Implant according to one of claims 1 to 6, characterised in that the elongated tubules (36) provided with connecting portions (35b) arranged parallel to each other, diaphragm-like ring members (35c) and openings or recesses (35a) arranged between the diaphragm-like ring members have a circular cross section.

8. Implant according to one of claims 1 to 6, characterised in that the elongated tubules (36) provided with connecting portions (35b) arranged parallel to each other, diaphragm-like ring members (35c) and openings or recesses (35a) arranged between the diaphragm-like ring members have an oval cross section.

9. Implant according to one of claims 1 to 6, characterised in that the elongated tubule (36) provided with connecting portions (35b) arranged parallel to each other, diaphragm-like ring members (35c) and openings or recesses (35a) arranged between the diaphragm-like ring members has a double-symmetrical elliptical ring cross section.

10. Implant according to one of claims 7 to 9, characterised in that the ring members (35c) are separated by slots (35d) provided at any position on the circumference of the ring members (35c), said two parts being expandable towards each other.

11. Implant according to one of claims 1 to 9, characterised in that the openings (35a) which are connected to the inner space (35e) of the tubule (36) are configured as rectangular, square or trapezoidal and are arranged opposite one another.

12. Implant according to one of claims 1 to 9, characterised in that the openings (35a) which are connected to the inner space (35e) of the tubule (36) are configured oval or elliptical and are arranged opposite one another.

13. Implant according to claim 10 or 11, characterized in that the opening (35a) provided on one side of the tubule (36) and the opening (35 a') provided on the opposite side of the tubule (36) are arranged offset from each other in the axial direction.

14. Implant according to one of claims 1 to 12, characterised in that the diaphragm-like ring (35c) arranged between the openings (35a) is inclined in one direction or the other in the axial direction of the tubule (36).

15. Implant according to claim 13, characterised in that the diaphragm-like rings (35c) provided between the openings (35a) are alternately and oppositely inclined in the axial direction of the tubule (36).

16. Implant according to one of claims 1 to 15, characterized in that the pliant tubule (36) has a length extending at least along half the circumference of the exposed schlemm's canal (15) and is distally provided with a ring (37) supporting the inner wall (13 ") of the sclera (13).

17. Implant according to one of claims 1 to 15, characterized in that the pliant tubule (36) has a length extending along the entire circumference of the exposed schlemm's canal (15) and is distally provided with a ring (37) supporting the inner wall (13 ") of the sclera (13).

18. Implant according to one of claims 1 to 16, characterized in that the tubules (36) are made of a biocompatible flexible material, preferably a polymeric material with a thermal or mechanical shape memory function.

19. Implant according to claim 18, characterised in that the tubule (36) is flexible into an arc and is inserted in a cross-section deformable into the lumen (16) of the exposed annular schlemm's canal (15) and can return to its predetermined initial shape by body temperature.

20. Implant according to one of claims 1 to 19, characterized in that the tubules (36) are made of a biocompatible material, such as gold or nitinol.

21. Implant according to one of claims 1 to 19, characterized in that the tubule (36) is coated, preferably with heparin coating.