Ocular implant delivery device

[0052] Described herein are methods, devices and systems for easily, reproducibly, and safely filling an ocular implant with a material, such as a drug, and inserting the implant into a patient, such as a patient’s eye. Although specific reference is made to placement of devices in the eye, systems described herein can be used with many devices used in locations other than the eye, such as in orthopedic, dental, intraluminal and transdermal locations. The systems and methods described herein are well suited for use with many drug delivery devices, such as refillable diffusion based devices, and can be exceptionally well suited for diffusion devices having a porous drug release structure configured for extended release in which the porous structure inhibits flow of fluid during exchange.

[0053] FIG. 1A shows an implementation of a system for holding, filling, and/or delivering an ocular implant. The system 100 can include an ocular implant handling system including an implant carrier member 105 and a handle member 115. The system 100 can further include a fill syringe 205 (see FIG. IB). The fill syringe 205 can contain a therapeutic agent, such as a pre-filled syringe. The carrier member 105 is sized and shaped to initially store an implant 110 prior to implantation of the implant 110 into the eye. The fill syringe 205 can interface with the carrier member 105 to fill the implant 110 with a flowable material, such as a liquid drug or therapeutic agent. The fill syringe 205 can interdigitate with the carrier member

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105 holding the implant 110 and lock into a portion of the carrier member 105 (e.g. a guide sleeve), as will be described in more detail below. The therapeutic agent or agents suitable for use with the implant 110 can vary, for example, as described in U.S. Patent No. 8,623,395, entitled “Implantable Therapeutic Device,” which is incorporated here in its entirety. The therapeutic agent can include one or more of a variety of active ingredients of the therapeutic agent, a formulation of the therapeutic agent, a commercially available formulation of the therapeutic agent, a physician prepared formulation of therapeutic agent, a pharmacist prepared formulation of the therapeutic agent, or a commercially available formulation of therapeutic agent having an excipient. The therapeutic agent may be referred to with generic name or a trade name.

[0054] A portion of the carrier member 105 can guide and properly align a cannula or needle 210 of the syringe 205 with the fill port of the implant 110. The syringe 205 can interdigitate with this portion of the carrier member 105 and lock into it such that when the syringe 205 is removed, for example, after filling the implant 110 with the drug from the syringe 205, the syringe 205 and this portion of the carrier member 105 locked onto the syringe can be withdrawn together. As will be described in more detail below, once the fill syringe 205 is removed (e.g. after the implant 110 is filled with drug), the handle member 115 can be inserted into the carrier member 105 and used to remove the implant 110 from the carrier member 105. The handle member 115 and the carrier member 105 can interchangeably couple to the implant 110. The handle member 115 can be coupled to the carrier member 105 in a manner that attaches the implant 110 to the handle member 115 and detaches the implant 110 from the carrier member 105. The handle member 115 can then be used to position the implant 110 and insert the implant 110 into an eye. Each of these features will be described in more detail below. It

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PCT/US2015/040633 should be appreciated that the implant 110 can be pre-filled and stored within the carrier member 105. Alternatively, the implant 110 can be stored within the carrier member 105 while empty and filled prior to implantation in the eye, such as using a pre-filled syringe. It should also be appreciated that the implant 110 can be filled after implantation in the eye.

[0055] Generally, the implant 110 to be used with the system 100 described herein can include an internal reservoir. The reservoir can be a rigid-walled reservoir having a fixed volume. Alternatively, one or more of the reservoir walls can be configured to expand such that the reservoir volume changes depending on a fill status of the implant 110. The implant 110 can include a proximal retention structure 305 and an indentation 307 or narrowed region that is sized smaller than the retention structure 305. The indentation 307 can also be sized smaller than a shoulder region extending distal to the indentation 307. The indentation 307 can be sized to fit in an elongate incision. The proximal retention structure 305 can include an access port having a penetrable region. For example, the proximal retention structure 305 can include or be covered by a penetrable barrier or septum structure such that the reservoir can be filled with a material. One or more outlets can be positioned in fluid communication with the reservoir of the implant 110 such that therapeutic agent in the reservoir can be delivered to the patient. The one or more outlets can incorporate a porous structure including one or more of many porous structures such as sintered material, openings in a non-permeable material, openings having a size and number to release therapeutic agent at an intended rate, a plurality of holes etched in a material, a semipermeable membrane, or nano-channels, for example. It should be appreciated that the configuration of implant 110 that can used with the system 100 described herein can vary. The systems described herein can be used with or incorporate features of devices described in U.S. Patent No. 8,399,006, entitled “Posterior Segment Drug Delivery”; U.S. Patent No. 8,905,963,

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PCT/US2015/040633 entitled “Injector Apparatus and Method for Drug Delivery;” and U.S. Publication No. 2015/0080846, entitled “Insertion and Removal Methods and Apparatus for Therapeutic Devices,” the entire disclosures of which are incorporated herein by reference.

[0056] As best shown in FIGs. 2A-2B and also FIGs. 3A-3B, 4A-4B, and 5A-5C, the carrier member 105 can include a shell 101 and a guide sleeve 120. The guide sleeve 120 can be removably attached to the shell 101. The system 100 can also include an implant holder 125 configured to releaseably hold an ocular implant 110 within the shell 101. The implant holder 125 can be reversibly coupled to the shell 101 of the carrier member 105. As such that implant holder 125 can be an interchangeable element that can be coupled to the carrier member 105, for example prior to filling with a syringe 205, and can be released from the carrier member 105, for example after filling with a syringe 205 and prior to implantation in a patient using a delivery tool. Thus, the implant holder 125 can be interchangeably coupled with the carrier member and the delivery tool.

[0057] The shell 101 of the carrier member 105 can include a central channel 103 extending at least partially through an upper surface of a first side, such as its front side 107, from a proximal end 108 of the carrier member 105 towards a distal end region 109 of the carrier member 105 along a longitudinal axis. The central channel 103 can terminate at an opening or window 111 extending through a distal end region 109 of the shell 101. The implant 110 can be positioned by the implant holder 125 within the window 111. The shell 101 of the carrier member 105 can be generally ergonomically shaped such that a user can hold the carrier member 105 in one hand positioned around the underside of the carrier member 105. The central channel 103 can be available and readily visible on the front side 107 of the carrier member 105. The

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PCT/US2015/040633 shell 101 of the carrier member 105 can include one or more textured regions 112 or indentations on its external surface to improve a user’s grip on the carrier member 105 during use.

[0058] It should be appreciated that reference herein to terms such as “upper,” “lower,” “upwards,” “downwards,” “front,” “back,” “proximal,” “distal” are used herein for orientation from one point of view of a user operating the systems described herein and are not intended to be limiting.

[0059] The implant 110 can have an elongate axis extending through a center of the implant 110 from the proximal-most end to the distal-most end of the implant 110. The system 100 (and/or each of the components of the system) can also have an elongate axis that is concentric with the elongate axis of the implant 110 forming a longitudinal axis A with which each of the components of the system 100 are substantially aligned. When the implant 110 is held by the implant holder 125 within the carrier member 105, the elongate axis of the implant 110 can be aligned substantially with the longitudinal axis A of the system and the syringe 205 can be inserted substantially along the longitudinal axis A such that the needle 211 penetrates an upper surface of the implant 110. It should be appreciated that the syringe 205 can interdigitate within the central channel 103 along the longitudinal axis A or, in other implementations, can be inserted at an angle to the longitudinal axis A.

[0060] As mentioned, the carrier member 105 can include the guide sleeve 120 that can be removably attached within at least a region of the slot of the shell 101. The guide sleeve 120 can define a proximal port 113 into the central channel 103 of the shell 101 that allows for access to the slot from a proximal end of the shell 101. The guide sleeve 120 can help to ensure proper alignment between the syringe 205 and the implant 110 such that a needle 211 of the syringe 205 inserts through a septum or fill port of the implant 110. The guide sleeve 120 can

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PCT/US2015/040633 provide guiding alignment during insertion of the syringe 205 through the port 113 into the central channel 103 towards the implant 110 mounted within the implant holder 125 of the carrier member 105.

[0061] The configuration of the guide sleeve 120 can vary. The guide sleeve 120 can have a length such that it extends a distance between the proximal end 108 of the shell 101 or central channel 103 and a distal region of the central channel 103. The guide sleeve 120 can be relatively flush with a proximal end 108 of the shell 101 (see FIGs. 2A and 2B) or the guide sleeve 120 can extend a distance beyond the proximal end 108 of the shell 101, For example, as shown in FIG. 1A-1B. In this implementation, the guide sleeve 120 can incorporate a gripping element 121. The gripping element 121 of the guide sleeve 120 may have an ergonomic size and shape that facilitates it being grasped by a user, such as between the fingers of a user’s hand as will be described in more detail below.

[0062] In some implementations, the guide sleeve 120 can have a generally cylindrical shape. The guide sleeve 120 can be a generally cylindrical element having an overall c-shaped cross section such that the underside or back side of the guide sleeve 120 is cylindrical and the front side of the guide sleeve 120 is slotted or discontinuous (see FIGs. 4A-4B and also FIG. 5C). In this implementation when the guide sleeve 120 is reversibly coupled with the shell 101 in the central channel 103, the cylindrical lower surface of the guide sleeve 120 can abut a lower portion 104 of the shell 101 and the discontinuous portion of the guide sleeve 120 can align with the upper surface of the front side 107 of the shell 101.

[0063] As mentioned above and as best shown in FIG. IB and also in FIG. 9, the syringe 205 can have a body sized and shaped to be inserted into the central channel 103 of the shell 101 of the carrier member 105 via the port 113 such that a needle 211 of a needle assembly

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210 of the syringe 205 can be inserted into the implant 110 mounted via the implant holder 125 on the carrier member 105. The syringe 205 can fill the implant 110 with a liquid drug or any other liquid prior to inserting the implant 110 into the eye. The syringe 205 can have any of a variety of configurations as known in the art. In some implementations, the syringe 205 can include a reservoir 215 that may be pre-filled with a fluid drug or any other fluid. The reservoir 215 can include a proximal opening configured to receive a mechanism for expelling the fluid from the reservoir 215 through a distal opening of the reservoir 215. The mechanism for expelling the fluid from the reservoir 215 can be a plunger 225 including a piston rod 230 terminating at a piston head 235. The piston head 235 can be configured to contact the liquid to be injected from the reservoir 215 and maintain a seal as the plunger 225 is displaced distally within the reservoir 215. A stop element can be incorporated that prevents withdrawal of the piston rod 230 or piston head 235 through the proximal opening. A proximal end of the syringe 205 can include a flange 245 that can aid in the advancement of the plunger 225 within the reservoir 215 as is known in the art. As the syringe 205 is used to inject material into the implant 110 using the plunger 225, a user can apply a force against an upper surface of the flange 245 (e.g. with the user’s thumb) and apply a force against a lower surface of portion 250 (e.g. with a user’s finger) therein applying a squeezing pressure to the syringe 205 engaged with the carrier member 105.

[0064] The distal opening of the reservoir 215 can be in fluid communication with a needle assembly 210 coupled to the syringe by a luer 255 (see FIG. IB and FIG. 9). The needle assembly 210 can include a needle 211 and optionally a needle limiter 212 positioned around the needle 211. The needle limiter 212 can have a length such that a distal-most tip of the needle 211 extends only a short distance beyond the needle limiter 212 to prevent penetration of

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PCT/US2015/040633 the needle 211 within the implant 110 beyond that short distance so as not to damage the implant 110 during filling. As the distal-most tip of the needle 211 penetrates the septum or fill port of the implant 110, the needle limiter 212 can abut an internal region of the implant holder 125 or an upper surface of the implant 110 preventing the needle 211 from penetrating the implant 110 beyond a desired depth. The syringe 205 can include a needle cap configured to cover the needle 211 and needle limiter 212. The needle assembly 210 may be integrally formed with the syringe 205 or the needle assembly 210 may be detachable from the syringe 205.

[0065] As mentioned above, the guide sleeve 120 can be removably attached from within the central channel 103 of the shell 101. The shell 101 and/or the guide sleeve 120 can include a locking mechanism that reversibly secures the guide sleeve 120 to the shell 101. The locking mechanism can be released, for example, upon insertion of the syringe 205 as will be described in more detail below. After the syringe 205 has been inserted into the guide sleeve 120 positioned within the central channel 103 of the shell 101 such as to inject drug into the implant 110, the locking mechanism between the guide sleeve 120 and the shell 101 can unlock. The guide sleeve 120 can release from the shell 101 and lock onto the syringe 205 such that both the guide sleeve 120 and the syringe 205 can be removed from the shell 101 upon withdrawal of the syringe 205 from the implant 110. The locking mechanism can simultaneously release the guide sleeve 120 from the shell 101 and lock the guide sleeve 120 onto a region of the syringe 205. When the syringe 205 is inserted into the guide sleeve 120, which can be in locked engagement with the shell 101 of the carrier member 105, the locking mechanism holding the guide sleeve 120 onto the syringe 205 can be activated or locked and the locking mechanism locking the guide sleeve 120 to the shell 101 can be deactivated or unlocked. The respective locking mechanisms can activate/deactivate in a simultaneous or step-wise manner. Once the switch in

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PCT/US2015/040633 engagement occurs (i.e. locked engagement between the guide sleeve 120 and the shell 101 to an unlocked state and unlocked engagement of the syringe 205 and the guide sleeve 120 to a locked state), the syringe 205 can then be removed from the carrier member 105 with the guide sleeve 120 secured to the syringe 205. FIG. 6 shows an implementation of the system 100 with the syringe 205 inserted into the carrier 105. FIG. 7 shows an implementation of the system 100 after the syringe 205 has been used to fill the implant 110 and the syringe 205 has been decoupled from the carrier member 105. The guide sleeve 120 is shown detached from the carrier member 105 and is now attached to the syringe 205. It should be appreciated that unlocking or detaching the guide sleeve 120 from the carrier member 105 is not dependent upon filling the implant 110.

[0066] The locking mechanism between the shell 101 and the guide sleeve 120 can include one or more corresponding slots and tabs providing a fixed, but reversible coupling between the shell 101 and the guide sleeve 120. In one implementation and as best shown in FIGs. 3A-4B, 4A-4B, and 7, the guide sleeve 120 can include one or more slots 122 having a size and shape configured to accept tabs 405 of the shell 101 such that the tabs 405 reversibly insert through the slots 122 when the guide sleeve 120 is positioned within the central channel 103 of the shell 101. The slots 122 can be located on opposing sides of the guide sleeve 120. The guide sleeve 120 can also include one or more tabs 123 formed by a u-shaped slot 126 through a thickness of the guide sleeve 120. It should be appreciated that tabs 405 as well as tabs 123 can have a degree of flexibility such that they can move slightly with respect to the longitudinal axis A of the system to provide for reversible attachment between the guide sleeve 120 and the shell 101 as well as between the guide sleeve 120 and the syringe 205, which will be described in more detail below.

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[0067] FIGs. 3A-3B, 4A-4B and also FIGs. 8A-8B show an implementation of a locking mechanism that initially locks the guide sleeve 120 to the shell 101 of the carrier member 105. The shell 101 can include one or more tabs 405 configured to insert through one or more corresponding slots 122 in the guide sleeve 120. In FIG. 8A, the tabs 405 are shown in a first state that locks the guide sleeve 120 to the shell 101 of the carrier member 105. The flexible tabs 405 can extend through the corresponding slots 122 in the guide sleeve 120 preventing withdrawal of the guide sleeve 120 in a proximal direction along arrow P. In the locked first state, an edge of the slot 122 can abut a distal edge of the tab 405. FIG. 8B shows a syringe 205 inserted distally into the guide sleeve 120 such that an outer surface of the needle assembly 210 of the syringe 205 presses against an inner surface of the flexible tabs 405 urging them in outward direction. The proximal end of the tabs 405 can be ramped such that the outer surface of the needle assembly 210 can smoothly press against and slide along the inner surface of the tabs 405 as the syringe 205 is urged in a distal direction along arrow D. The tabs 405 can be urged back out the slots 122 in the guide sleeve 120 releasing the locking engagement between the slots 122 of the guide sleeve 120 and the tabs 405 of the shell 101. In the unlocked second state, the edge 124 of the slot 122 may no longer abut the distal edge 408 of the tab 405.

[0068] This same act of inserting the syringe 205 distally through the guide sleeve 120 releasing the locked engagement between the guide sleeve 120 and the shell 101 can also cause the guide sleeve 120 to lock onto a portion of the syringe 205. In some implementations, the one or more tabs 123 formed by the u-shaped slot 126 through a thickness of the guide sleeve 120, for example, in the cylindrical underside of the guide sleeve 120 (see FIG. 4B and also FIG. 9). Similar to the tabs 405 of the shell 101, the tab 123 on the guide sleeve 120 can flex inward and outward relative to a longitudinal axis A of the guide sleeve 120 to capture a corresponding

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PCT/US2015/040633 portion of the syringe 205. A free end 128 of the tab 123 can be angled or curved such that it projects inward towards the longitudinal axis of the guide sleeve 120, or have a feature that encroaches within the interior of the sleeve 120. When the syringe 205 is inserted distally through the guide sleeve 120 releasing the tabs 405 of the shell 101 from the slots 122 in the guide sleeve 120, the flexible tab 123 of the guide sleeve 120 can capture the corresponding portion of the syringe 205 preventing the syringe 205 from being detached from the carrier member 105 without the guide sleeve 120 being coupled to the syringe 205.

[0069] As mentioned previously, the guide sleeve 120 can include an inner diameter configured to receive the outer diameter of the syringe 205 such that the syringe 205 can be inserted through the guide sleeve 120 to inject drug into the implant 110 mounted within the implant holder 125 located distal to the guide sleeve 120 (see FIG. 9). The free end 128 of the flexible tab 123 of the guide sleeve 120 projecting inward towards the central longitudinal axis A of the system 100. The syringe 205 can urge the flexible tab 123 outward away from the central longitudinal axis A as the syringe 205 is inserted through the guide sleeve 120. Thus, the syringe 205 can be freely inserted in a distal direction along arrow D through the guide sleeve 120. However, the tab 123 can prevent the syringe 205 from being withdrawn in a proximal direction along arrow P away from the guide sleeve 120. As best shown in FIG. 9, a distal region of the syringe 205 can include a first portion 206 having a first outer diameter and a second portion 208 having a second outer diameter. The first portion 206 can be located distally to the second portion 208 and the first outer diameter can be larger than the second outer diameter. As the syringe 205 is inserted through the guide sleeve 120, the outer diameter of the first portion 206 can abut the free end 128 of the tab 123 urging the tab 123 outward. Once the first portion 206 is advanced distal to the tab 123, the free end 128 can flex back inward towards

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PCT/US2015/040633 the longitudinal axis A and towards the smaller diameter second portion 208 located proximal to the first portion 206. The first portion 206 can have a proximal ledge 209 such that if the syringe 205 is withdrawn in a proximal direction, the free end 128 of the tab 123 can abut the proximal ledge 209 and cause the now-released guide sleeve 120 to withdraw along with the syringe 205.

[0070] As mentioned above, an implant holder 125 can be removably attached within at least a region of the central channel 103 of the shell 101. The implant holder 125 can be positioned such that an interior 901 of the implant holder 125 is coaxial with the central channel 103 of the carrier member 105 and the guide sleeve 120 (see FIG. 2A). A proximal end 902 of the implant holder 125 can lie adjacent to the distal end of the guide sleeve 120 and a distal end 903 of the implant holder 125 can extend beyond the central channel 103 into the window 111. The interior 901 of the implant holder 125 can be configured to receive at least a portion of the needle assembly 210 of the syringe 205 (see FIG. 6), as will be described in more detail below.

[0071] Now with respect to FIGs. 10A-10G, the implant holder 125 can include a pair of moveable mating graspers 905a, 905b configured to releasably secure the implant 110 to the carrier member 105. As best shown in FIGs. 10F and 10G, the implant 110 can include a proximal retention structure 305 that can include an indentation 307 dimensioned to receive first protrusion 907a of a first grasper 905 a and a second protrusion 907b of a second grasper 905b to hold the implant 110 therebetween. The protrusions 907a, 907b can be shaped in a variety of ways to engage the implant 110, including lentoid, oval, elliptical, or circular structures. The protrusions 907a, 907b can include a structure similar to the shape profile or outer contour or corresponding geometry of the indentation of the implant 110.

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[0072] Still with respect to FIGs. 10F-10G, first protrusion 907a on the first grasper 905a can include a proximal surface 910a to engage a region of the distal surface 306a of the retention structure 305, and the second protrusion 907b on the second grasper 905b can include a proximal surface 910b to engage another region of the distal surface 306b of the retention structure 305. The first grasper 905 a can be urged toward the second grasper 905b to slide the first protrusion 907a and the second protrusion 907b into the indentation 307 of the retention structure 305 such that the proximal surfaces 910a, 910b engage the distal surfaces 306a, 306b. The graspers 905 a, 905b can extend substantially around a portion of the retention structure 305 of the implant 110 to hold the implant 110. The septum or fill port of the implant 110 can be available within the interior 901 of the implant holder 125 and the body of the implant 110 can extend beyond the implant holder 125. The implant 110 can be held by the implant holder 125 such that a longitudinal axis of the implant 110 is aligned substantially concentric or coaxial with the longitudinal axis A of the system 100.

[0073] The syringe needle 211 can be inserted coaxially along the axis A of the implant 110 such that the needle 211 of the syringe 205 is advanced along the axis A toward the proximal end of the implant 110. The needle 211 of the syringe 205 can penetrate the fill port until a needle stop 212 contacts the proximal surface 910 of the graspers 905 or a proximal end of the implant 110 preventing further penetration of the needle 211. The interior 901 of the implant holder 125 as well as the guide sleeve 120 can further aid in aligning the syringe 205 and the needle 211 with the implant 110 and with the longitudinal axis A. The implant holder 125 can additionally incorporate an opening into the interior 901 such that a needle can be inserted at an angle to the longitudinal axis A.

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[0074] The implant holder 125 can be an interchangeable element that can lock in an alternating fashion with different portions of the system 100, such as the shell 101 of the carrier 105 and a portion of the handle member 115. The proximal end 902 of the implant holder 125 can be reversibly coupled to a region of the shell 101 such as within the central channel 103 by a locking mechanism. The locking mechanism can be configured to unlock the implant holder 125 from the shell 101 and then lock the implant holder 125 onto the handle member 115 once the handle member 115 is inserted into the carrier member 105, which is described in more detail below. The implant holder 125 can be attached to the region of the shell 101 and then attached to the handle member 115 upon release from the shell 101. The locking mechanism can include an indentation 912 near a proximal end 902 of the implant holder 125 configured to receive a correspondingly shaped element 410 of the shell 101 (see FIG. 3 A and also FIG. 13). The indentation 912 can have smooth edges such that the implant holder 125 can be removed from the element 410, as will be described in more detail below. The locking mechanism can also include a tab 914 formed by a u-shaped slot 916 located adjacent the indentation 912, such as just distal to the indentation 912. The tab 914 can include a projection 918 on its inner surface (see FIG. 10F) configured to engage with a correspondingly shaped recess 505 within a region of the handle member 115 when the handle member 115 is inserted through the interior 901 of the implant holder 125 as will be described in more detail below.

[0075] As mentioned above, the system 100 can also include the handle member 115. After the syringe 205 is removed from the carrier 105 and the guide sleeve 120 has transferred attachment from the shell 101 of the carrier 105 to the syringe 205 as shown in FIG. 7, the handle member 115 can be attached to the implant holder 125 holding the implant 110 (see FIG. 11 and 12). The implant holder 125 can be interchangeably attached to the shell 101 of the

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PCT/US2015/040633 carrier 105 and the handle member 115. Insertion of the handle member 115 into the carrier member 105 can release the attachment of the implant holder 125 with the shell 101 and cause the attachment between the implant holder 125 and the handle member 115 such that the implant holder 125 can be removed from the carrier 105 and the handle member 115 can be used to insert the implant being held by the implant holder 125 into a patient.

[0076] The handle member 115 can include an elongated proximal portion 510 that can be grasped by a user and the distal attachment portion 130 that can releaseably attached to the implant 110 via the implant holder 125. The proximal portion 510 of the handle member 115 can be sized and shaped to be grasped by a user and can have an ergonomic shape that facilitates quick and easy positioning of the implant 110 and release of the implant 110 into the patient. The distal attachment portion 130 of the handle member 115 can be inserted into the central channel 103 of the carrier member 105 after removal of the guide sleeve 120 from the central channel 103. In this regard, the attachment portion 130 can removably attach, engage or otherwise mate with the implant holder 125 of the carrier member 105, which holds the implant 110 (see FIG. 11). Once attached to the implant holder 125, the handle member 115 can be removed from the carrier member 105 such that it takes the implant holder 125 (and attached implant 110) out of the carrier member 105 along with it. The handle member 115 can then be used to manipulate the implant 110 held by the implant holder 125 such that the implant 110 can be inserted into an eye. FIG. 12 shows handle member 115 after it has been removed from the carrier member 105 with the removable implant holder 125 now attached to the handle member 115.

[0077] As described above and with respect to FIG. 13, the proximal end 902 of the implant holder 125 can be reversibly coupled to a region of the shell 101 by a locking

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PCT/US2015/040633 mechanism configured to unlock the implant holder 125 from the shell 101 and lock the implant holder 125 onto the handle member 115 once the handle member 115 is inserted into the carrier member 105. The locking mechanism can include the indentation 912 located near a proximal end 910 of each grasper 905 and the tab 914 adjacent the indentation 912 having the projection 918 on its inner surface. The projection 918 can have a ramped proximal end and a flat lower surface 920. When the implant holder 125 is locked to the shell 101, the correspondingly-shaped element 410 of the shell 101 can rest within the indentation 912. When the attachment portion 130 of the handle 115 is inserted through the implant holder 125, the projection 918 on the inner surface of the tab 914 can insert within the recess 505 near the distal end of the attachment portion 130. Distal movement of the attachment portion 130 along arrow D through the interior 901 of the implant holder 125 can cause the tab 914 to flex slightly outward as the outer surface of the distal end of the attachment portion 130 slides past the ramped surface of the projection 918 on the inner surface of the tab 914. Once the projection 918 aligns with the recess 505, the tab 914 can flex back inward such that the projection 918 snaps into the recess 505. The recess 505 and the projection 918 can have corresponding shapes such that the projection 918 can be received at least in part within the recess 505. Further distal movement of the handle 115 through the interior 901 of the implant holder 125 can be prevented due to contact between the distal-most end of the attachment portion 130 and a surface 925 of the interior 901 of the implant holder 125. Thus, a region of the attachment portion 130 between the recess 505 and the distalmost end of the attachment portion 130 can be captured between the projection 918 and this surface 925 (see FIG. 13). Proximal withdrawal of the handle 115 along arrow P from the central channel 103 of the shell 101 can cause a lower surface 920 of the projection 918 to abut a

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PCT/US2015/040633 distal wall 515 of the recess 505 causing the implant holder 125 to be withdrawn with the handle 115 in a proximal direction along arrow P out from the central channel 103.

[0078] Now with regard to FIGs 14A-14D, the handle member 115 can have at least one deployment mechanism including an actuator 705, such as a button, knob, slider, etc., that can be actuated to detach the implant 110 from the implant holder 125 and handle member 115. The actuation of the actuator 705 can simply release the implant 110 or it can push or otherwise expel the implant 110 from the handle member 115. FIGS. 14A and 14B shows an implementation of a deployment mechanism that releases the implant 110 from the handle member 115 upon actuation of the actuator 705. As described above, the implant holder 125 can include a pair of movable tips or graspers 905 that grasp the implant 110 such that when the handle member 115 is inserted within the interior 901 of the implant holder 125 the graspers 905 secure the implant 110 to the handle member 115. In the initial state shown in FIG. 14A, the graspers 905 can be positioned such that they hold the implant 110 in a secured position relative to the handle member 115. Once the actuator 705 is depressed, the graspers 905 can separate and release the implant 110 as shown in FIG. 14B. FIG. 15A-15B show cross-sectional views of an implementation of the deployment mechanism. The actuator 705 can be pressed (or slide) so as to exert a force onto a spring held slider member 1005. The force of the actuator 705 can slide the slide member 1005 to a position that causes the graspers 905 to open. The amount of force required to slide the slider member 1005 forward and open the graspers 905 can be variable. The slider member 1005 and the actuator interface at ramped connection can have different ramp angles resulting in a smoothing of the force required for the user to open the handle tips.

[0079] In an implementation, the actuator 705 can include an actuator element 701 configured to pivot around a pivot pin 710 when the actuator 705 is depressed towards an upper

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PCT/US2015/040633 surface 520 of the handle member 115. The actuator element 701 can also include a projection 715 extending from its lower surface 720 such that as the element 701 pivots around the pivot pin 710 the projection 715 is moved downwards such that the ramped surface 725 of the projection 715 slides along a ramped surface 1010 of the slider member 1005. This contact between the ramped surface 725 of the projection 715 against the ramped surface 1010 of the slider member 1005 can cause the slider member 1005 to move in a proximal direction against the force of the spring 730 compressing the spring 730. The slider member 1005 can have a forked region 1015 near its distal end. The attachment portion 130 of the handle member 115 can interface with the forked region 1015. The attachment portion 130 can include a first arm 525 rotatably coupled to a second arm 530 around a pivot point 535. The first arm 525 and second arm 530 can be biased such as by a spring or other element such that their distal ends 540 are urged towards one another. As described above, the distal region 540 of the arms 525, 530 can extend within the interior 901 of the implant holder 125 such that the projections 918 of the implant holder 125 mate with the recesses 505 on the arms 525, 530. A region 545 of the arms 525, 530 proximal of the pivot point 535 can interface with the forked region 1015 of the slider member 1005. A first prong 1020a of the forked region 1015 can rest against a first region 550 of the arm 525 and a second prong 1020b of the forked region 1015 can rest against a second region 550 of the arm 530 (see FIG. 14A). When the slider member 1005 is moved in a proximal direction along arrow P, the first and second prongs 1020a, 1020b can slide relative to the arms 525, 530 such that they abut a ramped proximal end 545 of each respective arm 525, 530 and cause the arms 525, 530 to open or pivot relative to one another around pivot point 535. The distal region 540 of the arms 525, 530 can move away from one another in a scissor-like movement. This, in turn, can cause the distal region 540 of the arms 525, 530 engaged with the

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PCT/US2015/040633 projections 918 of the implant holder 125 to press against the inner surface of the implant holder 125 and can cause the graspers 905 to likewise move away from one another releasing the implant 110 held therebetween (see FIG. 14B).

[0080] The actuator element 701 can be arranged relative to the arms 525, 530 of the handle member 115 such that as the actuator element 701 is pressed downwards towards the upper surface of the handle member 115, the arms 525, 530 can each move outward at an angle away from the longitudinal axis A of the system 100 and from one another. The arms 525, 530 can be configured to move away from one another such that one arm moves to a first side and the opposing arm moves to a second opposite side away from the longitudinal axis A of the system 100. The arms 525, 530 also can be configured to move away from one another such that one arm moves upwards and one arm moves downwards away from the longitudinal axis A of the system 100. As mentioned previously, reference herein to terms such as “upper,” “lower,” “upwards,” “downwards,” “front,” “back,” “proximal,” “distal” etc. are used herein for orientation from one point of view of a user operating the systems described herein and are not intended to be limiting. For example, the actuator element 701 can be positioned on an upper surface of the handle member 115 from the point of view of the user such that the actuator element 701 is pressed using a thumb and the actuator element 701 moved towards the upper surface of the handle member 115. The actuator element 701 also can be positioned on a lower surface of the handle member 115 from the point of view of the user such that the actuator element 701 is pressed using a finger and the actuator element 701 moved towards the lower surface of the handle member 115.

[0081] One or more components of the system 100 can be provided as a kit. The kit can include sterile packaging within which one or more components of the system 100 can be

WO 2016/011191

PCT/US2015/040633 contained including the carrier member 105 having a guide sleeve 120 and implant holder 125 attached. An implant 110 can be held within the implant holder 125 or the implant 110 can be contained within sterile packaging separated from the system 100 such that the implant 110 is engaged with the implant holder 125 after the sterile kit has been opened. The kit can further include a handle member 115. The kit can further include needle assembly 210 configured to couple to a pre-filled syringe. Alternatively, the kit can include the syringe. The kit can further include a removal tool. In some implementations, the kit can include a carrier member 105 having a guide sleeve 120 and having an implant holder 125 coupled to the shell 101 of the carrier member 105. The implant holder 125 can be reversibly coupled to an implant 110. The implant 110 can be empty. In an interrelated implementation, the kit can further include a handle member 115 configured to engage with the implant holder 125 holding the implant 110 after the implant 110 has been filed with a drug. In an interrelated implementation, a syringe 205 can be provided that is configured to interdigitate with a portion of a carrier member 105 such that a needle of the syringe 205 can insert through a proximal portion of the implant 110 being held by the carrier member 105 to fill the implant 110 with a drug. The syringe 205 can be pre-filled with one or more therapeutic agents. The carrier member 105 can include a guide sleeve 120 configured to lock onto a portion of the syringe 205 upon insertion of the syringe 205 into the guide sleeve 120 of the carrier member 105. The implant 110 can be held by an implant holder 125 locked onto the carrier member 105, such as within the central channel 103. The implant holder 125 holding the implant 110 can attach to a portion of a handle member 115 after removal of the syringe 205 from the carrier member 105 upon filling of the implant 110. The handle member 115 having the implant holder 125 now attached to it can be used to deliver the implant 110 held within the implant holder 125 into a target location of the patient. In an interrelated

WO 2016/011191

PCT/US2015/040633 implementation, the kit can include a carrier member 105 having a shell 101 and a guide sleeve 120, and an implant holder 125 holding an implant 110. The carrier member 105 can have a central channel 103 that facilitates access to the implant 110 being held by the implant holder 125, such as for filling with a syringe 205. The syringe 205 can be part of the kit or a separate component. The syringe 205 can be pre-filled with one or more therapeutic agents or can be empty. The handle member 115 can also be part of the kit or a separate component. The implant 110 can be part of the kit or a separate component. In an interrelated aspect, all of the components can be provided as a single kit or can be provided as separate components.

[0082] While this specification contains many specifics, these should not be construed as limitations on the scope of what is claimed or of what may be claimed, but rather as descriptions of features specific to particular embodiments. Certain features that are described in this specification in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable sub-combination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a sub-combination or a variation of a sub-combination. Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. Only a few examples and implementations are disclosed. Variations, modifications and enhancements to the described

WO 2016/011191

PCT/US2015/040633 examples and implementations and other implementations may be made based on what is disclosed.

[0083] In the descriptions above and in the claims, phrases such as “at least one of’ or “one or more of’ may occur followed by a conjunctive list of elements or features. The term “and/or” may also occur in a list of two or more elements or features. Unless otherwise implicitly or explicitly contradicted by the context in which it is used, such a phrase is intended to mean any of the listed elements or features individually or any of the recited elements or features in combination with any of the other recited elements or features. For example, the phrases “at least one of A and Β;” “one or more of A and Β;” and “A and/or B” are each intended to mean “A alone, B alone, or A and B together.” A similar interpretation is also intended for lists including three or more items. For example, the phrases “at least one of A, B, and C;” “one or more of A, B, and C;” and “A, B, and/or C” are each intended to mean “A alone, B alone, C alone, A and B together, A and C together, B and C together, or A and B and C together.”

[0084] Use of the term “based on,” above and in the claims is intended to mean, “based at least in part on,” such that an unrecited feature or element is also permissible.