Patent Publication Number: US-2023158325-A1

Title: Methods and apparatus for medical treatment of patient tissues

Description:
RELATED APPLICATIONS 
     This patent application claims the benefit of U.S. Provisional Application No. 63/282,004, filed Nov. 22, 2021, and U.S. Provisional Application No. 63/320,800, filed Mar. 17, 2022, the disclosures of which are incorporated by reference in their entireties. 
    
    
     FIELD OF THE INVENTION 
     The present invention is directed to systems, methods and devices for medically treating patient tissues, and in particular, tissues of the human eye. 
     BACKGROUND 
     A number of surgical procedures for treating the tissue of an eye are known, including surgical procedures for treating glaucoma. For example, glaucoma filtering surgery or “trabeculectomy” is a known procedure for treating glaucoma. However, known surgical procedures may not always yield a bleb or capsule that is of the optimal size, configuration, and density surrounding tissue due to variability in surgical techniques and patient healing factors. 
     SUMMARY 
     Embodiments of the present disclosure address shortcomings of known surgical procedures for treating glaucoma. 
     In an embodiment, the present invention is a collagen cross-linking system for treating a tissue of a patient. The system includes a catheter, a fluid source and a light source. The catheter comprises a flexible shaft and a conforming member, the flexible shaft having a distal end, a proximal end, a shaft body extending between the distal end and the proximal end, the shaft body defining a lumen, the conforming member being fixed to the catheter shaft near the distal end, the conforming member comprising a membrane defining a cavity in fluid communication with the lumen. The fluid source is operatively coupled to the proximal end of the catheter, the flexible shaft of the catheter being adapted and configured so that a flow of photosensitizing fluid provided by the fluid source flows through the membrane of the conforming member. The light source is operatively coupled to the proximal end of the catheter, the catheter being adapted and configured so that photo-activating light generated by the light source passes through the membrane of the conforming member. 
     In another embodiment, the present invention is directed to a method for the medical treatment for treating a target tissue in a patient&#39;s body. The method comprises the following steps:
         positioning a conforming member near the target tissue, the conforming member comprising a membrane;   directing a flow of photosensitizing fluid to impinge upon the target tissue, wherein the photosensitizing fluid flows through the membrane of the conforming member; and   irradiating the target tissue with photo-activating light that passes through the membrane of the conforming member.       

     In another embodiment, the present invention is directed to an implantable aqueous humor wicking device for transmission of aqueous humor in an eye of a patient. The device comprises a tube having an anterior end configured to interface with an anterior chamber of the eye of the patient, and a posterior end, the tube defining a flow channel for transmission of the aqueous humor of the eye of the patient from the anterior chamber to the posterior end of the tube. The device also comprises a wicking portion coupled to the posterior end of the tube and configured to absorb and retain aqueous humor received from the tube, the wicking portion comprising a biocompatible absorbent woven material, and defining an interior cavity receiving the posterior end of the tube. The biocompatible absorbent woven material of the wicking portion is configured to cause the aqueous humor to flow from the anterior chamber to the wicking portion due to a capillary action produced by the absorbent woven material. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The drawings included in the present patent application are incorporated into, and form part of, the specification. They illustrate embodiments of the present disclosure and, along with the description, serve to explain the principles of the disclosure. The drawings are only illustrative of certain embodiments and do not limit the disclosure. 
         FIG.  1    is a stylized representation of a medical procedure in accordance with the detailed description. 
         FIG.  2    is a stylized perspective view showing the eye of a patient. 
         FIG.  3    is a stylized cross-sectional view taken along section plane shown in  FIG.  2   . 
         FIG.  4    is a stylized diagram view showing a human face including a pair of eyes. 
         FIG.  5 A  is a stylized diagram showing four regions an eye. 
         FIG.  5 B  is a stylized diagram showing a region of an eye. 
         FIG.  6 A  is a stylized diagram showing an example incision in an eye. 
         FIG.  6 B  is a stylized diagram showing a collagen cross-linked region of an eye. 
         FIG.  7 A  is a stylized diagram showing an example peritomy incision in an eye. 
         FIG.  7 B  is a stylized diagram showing a trabeculectomy pocket in an eye. 
         FIG.  8    is a stylized diagram showing an example single quadrant peritomy in an eye. 
         FIG.  9    is a stylized diagram showing an example treatment pattern for use with methods and apparatus in accordance with this detailed description. 
         FIG.  10    is a stylized diagram showing an additional example treatment pattern for use with methods and apparatus in accordance with this detailed description. 
         FIG.  11    is a stylized plan view illustrating an example collagen crosslinking system in accordance with this detailed description. 
         FIG.  12    illustrates an example collagen crosslinking system in accordance with this detailed description. 
         FIG.  13 A  is a stylized cross-sectional view showing an eye. 
         FIG.  13 B  is an enlarged, stylized cross-sectional view showing a portion of the eye illustrated in  FIG.  13 A . 
         FIG.  13 C  is an enlarged, stylized cross-sectional view showing a portion of  FIG.  13 B . 
         FIG.  14    is a stylized diagram illustrating an example method of treatment performed on an eye, with the eye shown as a cross-sectional view. 
         FIG.  15    is a stylized diagram illustrating an example method of treatment performed on an eye. 
         FIG.  16    is a stylized diagram showing an eye. An incision has been made in the tissue of the eye in the embodiment of  FIG.  16   . 
         FIG.  17 A  and  FIG.  17 B  are stylized diagrams illustrating a medical procedure in accordance with this detailed description. In  FIG.  17 A , an incision has divided a tissue into a first portion and a second portion. In  FIG.  17 B , collagen crosslinking across the incision is illustrated using a pattern of cross-hatched lines. 
         FIG.  18 A  and  FIG.  18 B  are stylized diagrams illustrating a medical procedure in accordance with this detailed description. The stylized diagram of  FIG.  18 A  includes a cross-sectional view of a region of tissue defining a fluid flow channel. In  FIG.  18 B  collagen crosslinking in the tissue is illustrated using a pattern of cross-hatched lines. 
         FIG.  19    is a stylized diagram illustrating an aqueous humor wicking device in a perspective view, according to an embodiment. 
         FIG.  20    is a view in cross section of the aqueous humor wicking device of  FIG.  19   . 
         FIG.  21    is a stylized diagram illustrating a barbed portion of the aqueous humor wicking device of  FIGS.  19 - 20   . 
         FIG.  22    is a stylized diagram illustrating an embodiment of an aqueous humor wicking device with an aqueous flow direction indicator. 
         FIG.  23    is a stylized diagram illustrating placement of a portion of an aqueous humor wicking device between tissue layers of an eye. 
         FIG.  24    is a stylized diagram of an embodiment of a wicking device. 
         FIG.  25    is a stylized diagram illustrating fluid flow out of an aqueous humor wicking device. 
         FIG.  26    is a stylized diagram illustrating embodiment of a tubeless aqueous humor wicking device in fluid communication with the eye. 
         FIG.  27    is a stylized diagram of a portion of the device of  FIG.  25    in fluid communication with the anterior chamber of the eye. 
         FIG.  28    is a stylized diagram illustrating another embodiment of an aqueous humor wicking device. 
         FIG.  29    is a stylized diagram illustrating a cytokine-adsorbent wicking device in cross section as implanted into an eye, according to an embodiment. 
         FIG.  30    is a stylized diagram illustrating a cytokine-adsorbent wicking device in cross section, according to another embodiment. 
         FIG.  31    is a front perspective view of a cytokine-adsorbent device, according to an embodiment. 
         FIG.  32    is a stylized diagram illustrating an aqueous filtering system in cross section as implanted into an eye, according to an embodiment. 
     
    
    
     While the embodiments of the disclosure are amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the disclosure to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure. 
     DETAILED DESCRIPTION 
       FIG.  1    is a stylized representation of a medical procedure in accordance with this detailed description. In the example procedure of  FIG.  1   , a physician is treating the eye of a patient. The left hand of the physician is shown holding a portion of a catheter  100  in the example embodiment of  FIG.  1   . In some example methods, a treatment procedure may include making incisions using a scalpel. The catheter  100  may be used to promote collagen crosslinking across incisions in tissue to promote healing of the tissue in some example methods. In some example methods, a conformer may be used to arrange the tissue in a desired configuration. In some example methods, a conformer may be used to apply pressure to tissue during collagen crosslinking. In some example embodiments, the conformer may comprise an inflatable member. During the procedure illustrated in  FIG.  1   , the physician may view the eye of the patient using a microscope  101 . 
       FIG.  2    is a stylized perspective view showing the eye  20  of a patient. In the embodiment of  FIG.  2   , the upper and lower eyelids of the eye are held open with surgical tools  21  so that the eye is accessible to the physician. The cornea of the eye  20  meets the sclera of the eye  20  at the limbus. The conjunctiva of the eye  20  is loose connective tissue that covers the surface of the eyeball (bulbar conjunctiva) and doubles back upon itself to form the inner layer of the eyelid (palpebral conjunctiva). The conjunctiva is firmly adhered to the sclera at the limbus, where it meets the cornea. 
       FIG.  3    is a stylized cross-sectional view taken along the plane XP shown in  FIG.  2   . With reference to  FIG.  2   , it will be appreciated that the plane XP (shown with dashed lines) intersects the sclera of the eye  20 . With reference to  FIG.  3   , it will be appreciated that a portion of a device is located between the conjunctiva and the scleral bed of the eye. In an embodiment, the device may be a distal end  103  of a catheter  100 , as described further below. The Tenon capsule is also visible in  FIG.  3   . The Tenon capsule is a thin membrane that envelops the eyeball from the optic nerve to the corneal limbus and forming a socket in which the eye moves. 
     An example therapy method illustrated in  FIG.  3    includes delivering a flow of photosensitizing fluid  109  to a target region of tissue  151  and irradiating the target region with photo-activating light. In the stylized diagram of  FIG.  3   , photo-activating light emitted from the device is illustrated using solid triangles. The flow of photosensitizing fluid exiting the device is illustrated using solid circles  109  in the stylized diagram of  FIG.  3   . In some example embodiments, the photosensitizing fluid  109  comprises riboflavin. In some example embodiments, the photosensitizing fluid comprises oxygen. 
       FIG.  4    is a stylized diagram view showing a human face including a pair of eyes  20 . For purposes of illustration, each eye  20  is divided into four portions using dashed lines in  FIG.  4   . The four portions are labeled S, I, N, and T. In the example embodiment of  FIG.  4   , portion S is a superior portion of each eye and portion I is an inferior portion of each eye. Portion N is a nasal portion of each eye and portion T is a temporal portion of each eye in the example embodiment of  FIG.  4   . 
       FIG.  5 A  is a stylized diagram showing four regions an eye  20 . The four regions are labeled A, B, C, and D in  FIG.  5 A . In the example embodiment of  FIG.  5 A , region A corresponds to a superotemporal quadrant of the eye and region C corresponds to an inferotemporal quadrant of the eye. Region B corresponds to a superonasal quadrant of the eye and region D corresponds to an inferonasal quadrant of the eye in the example embodiment of  FIG.  5 A . 
       FIG.  5 B  is a stylized diagram showing a region E of an eye  20 . In the example embodiment of  FIG.  5 B , with an apex of the region E is located toward the limbus of the eye. In the example embodiment of  FIG.  5 B , region E has a shape that fans out as region E extends away from the limbus L of the eye. 
       FIG.  6 A  is a stylized diagram showing an example incision  113  in an eye  20 . In the example embodiment of  FIG.  6 A , the incision  113  begins at a location 4 mm from the limbus L of the eye  20 . The incision has a length of 2 mm in the example embodiment of  FIG.  6 A .  FIG.  6 B  is a stylized diagram showing a collagen cross-linked region of an eye  20 . Example boundaries of the collagen cross-linked region  115  are illustrated using dashed lines in  FIG.  6 B . In the example embodiment of  FIG.  6 B , the collagen cross-linked region has an inner boundary located 2 mm from the limbus L of the eye  20 . The collagen cross-linked region  115  has an outer boundary located 14 mm from the limbus L of the eye  20  in the example embodiment of  FIG.  6 B . 
       FIG.  7 A  is a stylized diagram showing an example peritomy incision in an eye  20 . In the example embodiment of  FIG.  7 A , the peritomy incision  117  has an arcuate shape that is offset from the limbus L of the eye  20 . The peritomy incision  117  has a length of 4 mm in the example embodiment of  FIG.  7 A .  FIG.  7 B  is a stylized diagram showing a trabeculectomy pocket  119  in an eye  20 . Example boundaries of the trabeculectomy pocket are illustrated using dashed lines in  FIG.  7 B . 
       FIG.  8    is a stylized diagram showing an example single quadrant peritomy in an eye  20 . In the example embodiment of  FIG.  8   , the single quadrant peritomy includes an arcuate portion that is off set from the limbus of the eye. Example methods in accordance with this detailed description may include implanting a device in the eye of a patient. Examples of devices that may be suitable in some applications include tube shunts (e.g., the PRESERFLO MicroShunt marketed by Santen Pharmaceutical Co. Ltd.), glaucoma implants (e.g., the BAERVELDT Glaucoma Implant marketed by Johnson and Johnson) and other devices used to treat glaucoma (e.g. the Ahmed valve). 
       FIG.  9    is a stylized diagram showing an example treatment pattern P 1  for use with methods and apparatus in accordance with this detailed description. In example embodiment of  FIG.  9   , the example treatment pattern P 1  has a shape that is analogous to the pattern of lines seen on a pumpkin. The treated areas of tissue are illustrated by a pattern of crosshatch lines L 1  to L 5  and line L 6  in  FIG.  9   . With reference to  FIG.  9   , it will be appreciated that the treatment pattern includes areas of untreated tissue that are encircled by areas of treated tissue. 
       FIG.  10    is a stylized diagram showing an additional example treatment pattern P 2  for use with methods and apparatus in accordance with this detailed description. The treated areas of tissue are illustrated by a pattern of crosshatch lines L 1  and L 2 , circumferential line L 3  and line L 4 , in  FIG.  10   . With reference to  FIG.  10   , it will be appreciated that the treatment pattern includes untreated areas of tissue that are encircled by treated areas of tissue. In example embodiment of  FIG.  10   , the example treatment pattern includes a plurality of lines that cross each other in a crisscross pattern. 
       FIG.  11    is a stylized plan view illustrating an example collagen crosslinking system  90  in accordance with this detailed description. The system of  FIG.  11    includes a catheter  100 , a light source  150  and a fluid flow source  160 . In the example embodiment of  FIG.  11   , the catheter has a distal end  103 , a proximal end  105 , and a flexible shaft  107  extending between the distal end and the proximal end. The fluid flow source  160  is operatively coupled to the shaft of the catheter in the example embodiment of  FIG.  11   . 
     In some example embodiments, the flexible shaft  107  of the catheter  100  is adapted and configured so that a flow of photosensitizing fluid  109  provided by the fluid flow source  160  is delivered to a location proximate the distal end  103  of the catheter  100 . The flow of photosensitizing fluid  109  exiting a distal portion  103  of the catheter  100  is illustrated using solid circles in the stylized diagram of  FIG.  11   . In an embodiment, the photosensitizing fluid  109  may be dispensed through apertures in, or a membrane of, flexible shaft  107  at distal end  103 . In some example embodiments, the photosensitizing fluid  109  comprises riboflavin. In some example embodiments, the photosensitizing fluid  109  comprises oxygen. 
     In the example embodiment of  FIG.  11   , the light source  150  is operatively coupled to the shaft  107  of the catheter  100 . In some embodiments, the flexible shaft  107  of the catheter  100  is adapted and configured so that photo-activating light generated by the light source  150  is emitted from a distal portion  103  of the catheter  100 . In the stylized diagram of  FIG.  11   , photo-activating light emitted from the catheter  100  is illustrated using solid triangles. In some example embodiments, the photo-activating light provided by the light sources  150  comprises ultraviolet light. In some example embodiments, the light source  150  generates light having a wavelength of 370 nm. In some embodiments, the light exits through apertures in, or light-permeable membrane of, distal end  103  of flexible shaft  107 . 
     In some embodiments, the catheter shaft  107  is dimensioned and configured such that the distal end  103  of the catheter  100  can enter the body of a patient through a small incision, such as one of the incisions described above, and delivery therapy to a location inside the body. In some embodiments, a system  90  in accordance with this detailed description provides the ability to precisely target tissue therapy that promotes collagen crosslinking in the target area of a tissue. 
       FIG.  12    illustrates an example collagen crosslinking system in accordance with this detailed description. The illustration shown in  FIG.  12    is not meant to imply physical or architectural limitations to the manner in which an illustrative embodiment may be implemented. Other components in addition to or in place of the ones illustrated may be used. Some components may be optional. Also, some blocks may illustrate functional components. One or more of these blocks may be combined, divided, or combined and divided into different blocks in some implementations. The example system shown in  FIG.  12    includes a fluid flow source  160  capable of providing a flow of fluid. The fluid flow source  160  comprises a syringe  162  in the example embodiment of  FIG.  12   . In the example embodiment of  FIG.  12   , the syringe  162  comprises a syringe barrel  164  and a syringe plunger  166 , a distal portion of the syringe plunger  166  is slidingly received in the syringe barrel  164 . The syringe barrel  164  and the syringe plunger  166  cooperate to define the fluid chamber  168  in the embodiment of  FIG.  12   . In some example embodiments, the fluid flow source  160  may include an actuator that selectively causes the syringe  162  to expel fluid from the fluid chamber  168 . Fluid flow sources that may be suitable in some applications are disclosed in the following United States patents all of which are hereby incorporated by reference herein: U.S. Pat. Nos. U.S. Pat. Nos. 9,113,843, 9,220,834, 9,241,641, 9,333,293, 9,352,105, and 9,457,140. 
     The collagen crosslinking system of  FIG.  12    includes a catheter  100  having a distal end  103 , a proximal end  105 , and a flexible shaft  107  extending between the distal end and the proximal end. The catheter  100  includes a hub  121  that is fixed to the catheter shaft  107  near the proximal end of the catheter. The fluid flow source of the system is operatively coupled to the shaft of the catheter via the hub  121  in the example embodiment of  FIG.  12   . In the example embodiment of  FIG.  12   , a light source  150  is also operatively coupled to the shaft  107  of the catheter  100  via the hub  121 . In some embodiments, the flexible shaft  107  of the catheter  100  is adapted and configured so that photo-activating light generated by the light source  150  is emitted from a distal portion  103  of the catheter  100 . 
     In the example embodiment of  FIG.  12   , the catheter  100  includes a conformer  123  that is fixed to the distal end  103  of the catheter shaft  107 . The conformer defines a cavity  125  that is disposed in fluid communication with a lumen  127  defined by the catheter shaft  107  in the example embodiment of  FIG.  12   . In some example embodiments, the conformer  123  comprises an inflatable member. In some example methods, a conformer  123  may be used to arrange the tissue in a desired configuration. In some example methods, a conformer  123  may be used to apply pressure to tissue during collagen crosslinking. In some example embodiments, the conformer  123  comprises a light permeable membrane and photo-activating light generated by the light source passes through the membrane of the conformer. In some example embodiments, the conformer  123  comprises a fluid permeable membrane and a flow of photosensitizing fluid  109  provided by the fluid flow source  160  passes through the membrane of the conformer  123 . 
       FIG.  13 A ,  FIG.  13 B  and  FIG.  13 C  are stylized cross-sectional views showing an eye  20 . The Tenon&#39;s capsule of the eye is visible in  FIG.  13   . The Tenon&#39;s capsule is a thin membrane that envelops the eyeball from the optic nerve to the corneal limbus and forming a socket in which the eye moves. The Sub-tenon&#39;s space of the eye is shown using a pattern of crosshatch lines in  FIG.  13   . With reference to  FIG.  13   , it will be appreciated that the sub-Tenon&#39;s space is located between the Tenon&#39;s capsule and the sclera of the eye. 
       FIG.  13 B  is an enlarged cross-sectional view showing a portion of the eye  20  illustrated in  FIG.  13 A . It will be appreciated that the shaft  107  of a catheter  100  is extending between the conjunctiva and the scleral bed of the eye  20 . In the embodiment of  FIG.  13 B , a distal portion  103  of the catheter  100  is located in the sub-Tenon&#39;s space of the eye  20 . The catheter shaft  107  can be seen extending between the conjunctiva and the scleral bed of the eye  20  in  FIG.  13 B . The conjunctiva of the eye  20  a loose connective tissue that covers the surface of the eyeball (bulbar conjunctiva) and doubles back upon itself to form the inner layer of the eyelid (palpebral conjunctiva). The conjunctiva is firmly adhered to the sclera at the limbus, where it meets the cornea. The catheter shaft can be seen extending between the Tenon&#39;s capsule and the sclera of the eye  20  in  FIG.  13 B . 
       FIG.  13 C  is an enlarged cross-sectional view showing a portion of  FIG.  13 B . Example therapy methods in accordance with this detailed description may include delivering a flow of photosensitizing fluid  109  to a target region  153  of tissue and irradiating the target region  153  with photo-activating light. In the stylized diagram of  FIG.  13   , photo-activating light emitted from a distal portion a catheter  100  is illustrated using solid triangles and a flow of photosensitizing fluid exiting the distal portion of the catheter  100  is illustrated using solid circles. With reference to  FIG.  13 C , it will be appreciated that a distal portion of the catheter  100  is located in Tenon&#39;s capsule of the eye  20 . 
       FIG.  14    is a stylized diagram illustrating an example method of treatment performed on an eye  20 . The eye  20  is shown as a cross-sectional view in  FIG.  14   . In the example method illustrated in  FIG.  14   , eye  20  is the eye of a patient being treated patient for glaucoma. In some example methods, glaucoma may be treated, by forming a pathway that allows aqueous humor to flow out of the anterior chamber of the eye. In some example methods, glaucoma may be treated, by forming a pathway that allows aqueous humor to flow into a cavity defined by a bleb. An example bleb  127  is shown in the cross-sectional view of  FIG.  14   . In some embodiments, devices and methods described herein may be used to increase the strength of tissue healing at a location where a surgeon has created a bleb  127 . In some embodiments, devices and methods described herein may be used to achieve increased permeability of a bleb  127 . In some example embodiments, aqueous humor may pass through the wall of a bleb  127  and flow along the outer surface of the eye in a manner analogous to the flow of tears. 
     In the example embodiment of  FIG.  14   , a distal portion  103  of a catheter  100  is positioned near the bleb  127  formed in the eye  20 . The example therapy method illustrated in  FIG.  14    includes delivering a flow of photosensitizing fluid  109  to a target region  155  of the tissue and irradiating the target region with photo-activating light. In the stylized diagram of  FIG.  14   , photo-activating light emitted from a distal portion  103  of the catheter  100  is illustrated using solid triangles. The flow of photosensitizing fluid  109  exiting a distal portion  103  of the catheter  100  is illustrated using solid circles in the stylized diagram of  FIG.  14   . In some example embodiments, the photosensitizing fluid  109  comprises riboflavin. In some example embodiments, the photosensitizing fluid  109  comprises oxygen. In some embodiments, devices and methods described herein provide controlled, targeted, collagen crosslinking in tissue to improve biomechanical characteristics of the tissue. In some embodiments, devices and methods described herein strengthen tissue. In some embodiments, the strengthening of the tissue reduces stretch signals to fibroblasts. In some embodiments, the strengthening of the tissue reduces the likelihood that fibroblasts will transform into myofibroblasts. In some embodiments, devices and methods described herein inhibit excessive fibrosis. In some embodiments, devices and methods described herein fix tissues in place. In some embodiments, devices and methods described herein fix tissues in a way that prevents stretching of tissues during the healing phase. In some embodiments, devices and methods described herein fix tissues in a way that inhibits the “stretch” signal that promotes fibroblasts to transform into myofibroblasts. 
       FIG.  15    is a stylized diagram illustrating an example method of treatment performed on an eye  20 . With reference to  FIG.  15   , it will be appreciated that an aqueous humor drainage device has been implanted in the eye  20 . In some example methods, glaucoma may be treated by implanting one or more aqueous humor drainage devices  131  in the eye. In some cases, the aqueous humor drainage device  131  may provide a pathway that allows aqueous humor to flow out of the anterior chamber of the eye. The aqueous humor drainage device  131  shown in  FIG.  15    may be located, for example, under the episcleral of the eye  20 . 
     An example aqueous humor drainage device  131  is illustrated using dashed lines in  FIG.  15   . Example methods in accordance with this detailed description may include implanting a device in the eye of a patient. Examples of devices that may be suitable in some applications include tube shunts (e.g., the PRESERFLO MicroShunt marketed by Santen Pharmaceutical Co. Ltd.), glaucoma implants (e.g., the BAERVELDT Glaucoma Implant marketed by Johnson and Johnson) and other devices used to treat glaucoma (e.g. the Ahmed valve). In some cases, the aqueous humor drainage device  131  may provide a pathway that allows aqueous humor to flow into a reservoir under the episcleral of the eye. In the example embodiment of  FIG.  15   , the distal end of a catheter is positioned near the aqueous humor drainage device  131 . In some embodiments, devices and methods described herein inhibit excessive fibrosis. In some embodiments, devices and methods described herein provide lower postoperative intraocular pressure by performing collagen crosslinking in tissue to limit fibroblast proliferation and fibroblast migration. In some embodiments, devices and methods described herein provide lower postoperative intraocular pressure by performing collagen crosslinking in tissue to prevent excessive fibrosis. In some embodiments, devices and methods described herein provide lower postoperative intraocular pressure by performing collagen crosslinking in tissue to prevent scar formation. 
     The example therapy method illustrated in  FIG.  15    includes delivering a flow of photosensitizing fluid  109  to tissues located near the aqueous humor drainage device  131  and irradiating those tissues with photo-activating light. In the stylized diagram of  FIG.  15   , photo-activating light emitted from the distal end  103  of the catheter  100  is illustrated using solid triangles. The flow of photosensitizing fluid  109  exiting the distal end  103  of the catheter  100  is illustrated using solid circles in the stylized diagram of  FIG.  15   . In some embodiments, devices and methods described herein prevent migration of an implant by performing episcleral and/or subconjunctival collagen crosslinking in the tissues located near the implant. In some embodiments, devices and methods described herein prevent erosion of tissues located near an implant by performing episcleral and/or subconjunctival collagen crosslinking in the tissue. In some embodiments, devices and methods described herein prevent implant exposure by performing episcleral and/or subconjunctival collagen crosslinking in the tissues located near the implant. 
       FIG.  16    is a stylized diagram showing an eye  20 . With reference to  FIG.  16   , it will be appreciated that an incision  133  has been made in the tissue of the eye  20 . In some example methods, a treatment procedure may include making incisions  133  using a scalpel. Methods and apparatus in accordance with this detailed description may be used to promote collagen crosslinking across incisions in some example embodiments. In the example embodiment of  FIG.  16   , a distal portion  103  of a catheter  100  is located near the incision  133  in the tissue of the eye  20 . The example therapy method illustrated in  FIG.  16    may include delivering a flow of photosensitizing fluid  109  to a target region of the tissue and irradiating the target region with photo-activating light. In the stylized diagram of  FIG.  16   , photo-activating light emitted from the distal end  103  of the catheter is illustrated using solid triangles. The flow of photosensitizing fluid  109  exiting the distal end  103  of the catheter  100  illustrated using solid circles in the stylized diagram of  FIG.  16   . In some example embodiments, the photosensitizing fluid  109  comprises riboflavin. In some example embodiments, the photosensitizing fluid comprises oxygen. In some embodiments, devices and methods described herein provide controlled, targeted, collagen crosslinking in tissue to improve biomechanical characteristics of the tissue. In some embodiments, devices and methods described herein strengthen tissue. In some embodiments, devices and methods described herein inhibit excessive fibrosis. In some embodiments, devices and methods described herein prevent scar formation. In some embodiments, devices and methods described herein fix tissues in a way that prevents stretching of tissues during the healing phase. 
       FIG.  17 A  and  FIG.  17 B  are stylized diagrams illustrating a medical procedure in accordance with this detailed description. In the example embodiment of  FIG.  17 A , an incision has divided a tissue into a first portion  135  and a second portion  137 . In some example methods, a treatment procedure may include making incisions using a scalpel. With reference to  FIG.  17 A , it will be appreciated that the distal end  103  of a catheter  100  has been positioned near the incision in the tissue in the embodiment of  FIG.  17 A . In some example methods, a catheter may be used to promote collagen crosslinking across incisions in tissue to promote healing of the tissue. The example therapy method illustrated in  FIG.  17 A  includes delivering a flow of photosensitizing fluid  109  to a target region  157  of the tissue and irradiating the target region with photo-activating light. In the stylized diagram of  FIG.  17 A , photo-activating light emitted from the distal end  103  of the catheter  100  is illustrated using solid triangles. The flow of photosensitizing fluid  109  exiting the distal end  103  of the catheter illustrated using solid circles in the stylized diagram of  FIG.  17 A . In some example embodiments, the photosensitizing fluid  109  comprises riboflavin. In some example embodiments, the photosensitizing fluid  109  comprises oxygen. 
       FIG.  17 B  is a stylized diagram showing the tissue seen in  FIG.  17 A  after the catheter has been used to promote collagen crosslinking across incisions in tissue to promote healing of the tissue. The collagen crosslinking is illustrated using a pattern of crosshatched lines in  FIG.  17 B . The medical procedure illustrated in  FIG.  17 A  and  FIG.  17 B  may be used to treat various body tissues and may be used in various areas of medicine. By way of example and not limitations, the devices and methods described herein may be used for applications in ophthalmology, orthopedics, urology, plastic surgery, general surgery, thoracic surgery, and cardiology. Examples of applications in ophthalmology include treatment of glaucoma (e.g., improved wound healing for glaucoma drainage devices), treatment of the retina (e.g., treatment to prevent erosion of scleral implants), scleral crosslinking to prevent myopia progression, and oculoplastics (e.g., less invasive ptosis repair and blepharoplasty). Examples of orthopedic applications include hip cartilage resurfacing prior to hip replacement, knee cartilage resurfacing prior to knee replacement surgery, and strengthening fibrous cartilage around collagen discs to contain disc herniation. 
       FIG.  18 A  and  FIG.  18 B  are stylized diagrams illustrating a medical procedure in accordance with this detailed description. The stylized diagram of  FIG.  18 A  includes a cross-sectional view of a region  157  of tissue defining a fluid flow channel  141 . In some embodiments, devices and methods described herein may be used to reshape tissues into a desired configuration. In some embodiments, devices and methods described herein form tissue structures defining fluid flow channels  141  through the tissue. In some embodiments, devices and methods described herein form tissue structures that improve the transmission of aqueous humor in the eye  20  of a patient. With reference to  FIG.  18 A , it will be appreciated that the distal end of a catheter  100  has been positioned near the flow channel defined by the tissue in the embodiment of  FIG.  18 A . The example therapy method illustrated in  FIG.  18 A  includes delivering a flow of photosensitizing fluid  109  to a target region of the tissue and irradiating the target region with photo-activating light  109 . In the stylized diagram of  FIG.  18 A , photo-activating light emitted from the distal end  103  of the catheter  100  is illustrated using solid triangles. The flow of photosensitizing fluid exiting the distal end of the catheter illustrated using solid circles in the stylized diagram of  FIG.  18 A .  FIG.  18 B  is a stylized diagram showing the tissue seen in  FIG.  18 A  after the catheter  100  has been used to promote collagen crosslinking in the tissue. The collagen crosslinking is illustrated using a pattern of crosshatched lines in  FIG.  18 B . 
     Referring to  FIGS.  19 - 27   , embodiments of an aqueous humor wicking device  200  and its applications are depicted. The aqueous wicking device  200  may be used in conjunction with treatment methods described above with respect to  FIGS.  1 - 18   , or may be used independently, and as described further below with respect to the figures. The crosslinking treatment methods described above work most effectively with the aqueous wicking device  200  because it optimizes wound healing through multiple mechanisms to deliver the best postoperative outcome in terms of ideal postoperative intraocular pressure (IOP) as well as longevity of the surgical procedure. Performing glaucoma surgery using the crosslinking procedure alone may either have a higher than desired postoperative IOP because it does not have the increased surface area of outflow provided by the aqueous wicking device. Furthermore, without the microfilter membrane, proinflammatory mediators from the aqueous can still reach tissues beyond the glaucoma drainage device, cause increased scarring and a suboptimal IOP. Also, the woven design of the aqueous wicking device allows for the same amount of draining with a smaller footprint. A smaller footprint requires a smaller surgical dissection, which causes less trauma and tissue inflammation and results in improved surgical outcomes. The combined innovations of the crosslinking treatment methods, with microfilter membrane, and woven design will result in the optimal surgical outcomes and are all necessary components. 
     Referring specifically to  FIGS.  19  and  20   , aqueous wicking device  200  is depicted. In this embodiment, aqueous wicking device  200  includes tube  202  coupled with wicking portion  204 , which in an embodiment forms a woven wicking reservoir. In another embodiment described below with respect to  FIGS.  25 - 27   , aqueous wicking device  200  may not include a tube  202 . 
     Still referring to  FIGS.  19  and  20   , tube  202  defines flow channel  206  and has length L, outside diameter OD and inside diameter ID. Dimensions of length L may vary depending on a number of factors, including the dimensions of the particular wicking portion  204 , tube  202  and wicking portion  204  placement, and so on. Dimension of outside diameter OD and inside diameter ID may also vary depending on a number of factors, such as desired fluid flow through tube  202 , wicking or capillary or capillary action properties of wicking portion  204 , and so on. In an embodiment, tube  202  comprises a shunt or more particularly, a microshunt. 
     Tube  202  may be considered a resistive flow element in that the inside diameter and length of tube  202  present a resistance to the amount of aqueous that may flow out of the anterior chamber in response to capillary action produced by wicking portion  204 , as described further below. 
     Tube  202  defines anterior end  207  and posterior end  209 . Anterior end  207  is configured to interface directly with tissue and aqueous of the eye, as described further below, while posterior end  209  is configured to interface, or couple with, wicking portion  204 . 
     Wicking portion  204 , in an embodiment, —includes anterior end  210  and posterior end  212 . Wicking portion  204  also includes exterior walls or wall structure  214 . Walls  214  may comprise a single, integral cylindrical wall, or may comprise multiple walls, such as those depicted, e.g., a first or interior or bottom wall  214   a , a second or exterior or top wall  214   b , and a third or side wall. In the case of a square or rectangular cross section, an additional or fourth wall  214  may be included. 
     In an embodiment, wicking portion  204  comprises a biocompatible woven material capable of creating a capillary action, for example a polypropylene material used for FDA-approved glaucoma drainage implants. Such material may include Ahmed Implants S 2 ,S 3 ,B 1 ,PS 2 ,PS 3 ; Molteno Implants S 1 ,D 1 ,M 1 ,R 2 /L 2 ;DR 2 /DL 2 ,GS,GL 0 . Materials may also include Wicking Polytetrafluoroethylene (PTFE)/Expanded Polytetrafluorothylene ePTFE. Other examples of materials may be hydrogels. Embodiments of the invention are not limited to these particular examples, and may include other wicking materials capable of providing the desired capillary action required for the described devices and treatments herein. 
     Due to its wicking properties, wicking portion  204  functions as a liquid reservoir, retaining aqueous. In an embodiment, wicking portion  204  may define an optional reservoir cavity  208  formed by walls  214 . Reservoir cavity  208  may initially comprise an air pocket that after implantation may be partially or fully filled with aqueous, so as to increase the volumetric reservoir capacity of wicking portion  204 . In an embodiment, reservoir cavity  208  may initially be present before implantation, but after implantation, may diminished in size, or even completely removed, due to compression of wicking portion  204  upon implantation. 
     In embodiments, the material of wicking portion  204  is a flexible material which reduces the risk of device erosion. 
     Further, the use of woven materials increases surface area and aqueous transmission via increased capillary action. This potentially allows significant aqueous transmission with a relatively small device footprint. 
     In an embodiment, wicking portion  204  consists of a single material, which may be a woven material, such as one described above. In other embodiments, wicking portion  204  may comprise a composite material, i.e., more than one material or layer. In one such embodiment, which is described below in further detail, wicking portion  204  includes a multi-weave material that includes one or more layers of a coarse-weave material and one or more layers of a fine-weave material. 
     As depicted in  FIG.  19   , wicking portion  204  defines a length Lw, width Ww and height Hw. In an embodiment length Lw is generally greater than height Hw and width Ww such that wicking portion  204  is strip-like in character. As described below, wicking portion  204  may define other shapes. In an embodiment, height Hw is relatively small with respect to the eye, so that wicking portion  204  maintains an ultra-low profile. In an embodiment, height Hw is in a range of 0.1 mm to 0.6 mm. In one particular embodiment, height Hw is no greater than 0.4 mm. Having a low profile, or small height Hw, minimizes the stretch response for fibroblasts, since the tissues are not as stretched as much accommodate and cover the implant. Reducing the amount of stretch on the tissues reduces the signal to mechanoreceptors on the fibroblasts. Therefore this results in a reduced rate of transformation of fibroblasts to myofibroblasts. 
     In an embodiment, wicking portion  204  may comprise a single, integral structure, such as a single posterior strip. In other embodiments, wicking portion  204  may comprise multiple connected parts, such as a central posterior strip with multiple radiating strips, as described further below with respect to  FIG.  28   . 
     In an embodiment, wicking portion  204  may define a generally flat and low profile cross section when viewing an end of the wicking portion. In other embodiments, wicking portion  204  may define other shapes in cross section, such as a square or rectangular shape. 
     Referring specifically to  FIG.  20   , aqueous wicking device  200  is depicted in cross section. As depicted, posterior end  209  is inserted into wicking portion  204 , and terminates in reservoir cavity  208 . Anterior end  207  terminates outside and away from wicking portion  204 . Anterior end  207  is in fluid communication with posterior end  209 , and connected by fluid channel  206  of tube  202 . 
     At the region of wicking portion  204  where a portion of tube  202  enters wicking portion  204 , a biocompatible adhesive or sealant may be used to retain placement of tube  202  at wicking portion  204 . In other embodiments, tube  202  is coupled to wicking portion  204  simply by a friction fit. 
     In an embodiment, and as depicted, reservoir cavity  208  is generally larger than the portion of tube  202  that is inserted into the reservoir cavity, thereby creating a space around tube  202 . As described above, reservoir cavity  208  may be present prior to implantation, which allows for easier insertion of tube  202  into wicking portion  204 . However, reservoir cavity  208  may collapse fully or partially around tube  202  after implantation. In embodiment wherein reservoir cavity  208  is not fully collapsed after implantation, aqueous will enter the reservoir cavity  208  space prior to being transmitted through walls  214 , and the interstitial space about tube  202  allows newly-entering aqueous to be distributed within the cavity for eventual flow to the exterior of wicking portion  204 . In an embodiment wherein reservoir cavity  208  is fully or substantially collapsed, aqueous exits  202  and is drawn directly into wicking portion  204 . 
     Although somewhat flexible and to a certain degree compressible, the structure of wicking portion  204  provides a physical support to tube  202  so as to prevent fibrosis from sealing off the outlet of the tube. In any case, both tube  202  and wicking portion  204  may be configured to be periodically replaced over the lifetime of the patient. 
     The size and shape of reservoir cavity  208  may vary depending on whether it functions primarily as just a tube cavity for receiving tube  202 , or whether it is intended to include additional space to hold aqueous. In an embodiment, cavity  208  may the same or very close to the same size as that portion of tube  202  within cavity  208  such that tube  202  fits relatively tightly within wicking portion  204 . Such an embodiment may be useful in creating a lower profile device. In such an embodiment, when tube  202  is inserted into wicking portion  204 , the space of cavity  208  is filled, or substantially filled, with tube  202 . 
     In an alternate embodiment, a length of cavity  208  is longer than the portion of tube  202  within cavity  208 , and a circumference of cavity  208  is larger than the outside diameter of tube  202 , so as to allow aqueous to enter cavity  208  and flow about the interior space of cavity  208  prior to transmission through the weave material. 
     In an embodiment, superficial portions of wicking portion  204  may include a capsule or fibrosis marker. In an embodiment such a marker may comprise a blue color or other readily visible color. As the capsule around aqueous wicking device  204  heals, it is possible to assess the amount of light reflectivity and correlate that to the amount of scar tissue present, thereby informing postoperative care, which could include treatment with more steroids, NSAIDS, 5FU, MMC, MMP inhibitors, etc. 
     Referring to  FIG.  21   , in an embodiment, aqueous wicking device  200  or wicking portion  204  may include a plurality of bio-barbs  220 , including at posterior end  212 . Barbs  220  may extend transversely from wicking portion  204  as depicted, and may include relatively pointed or sharp end portions configured to pierce or otherwise grip tissue of the eye, e.g., the sclera, allowing scleral fixation of device  200  to the eye without the need for sutures. 
     Referring to  FIG.  22   , and as explained further below, after implantation into the eye, the capillary action of wicking portion  204  will draw aqueous from the anterior chamber of the eye into anterior end  207  of tube  202 , through tube channel  206  and into wicking portion  204 , followed by filtering of the aqueous and transmission of the aqueous to other areas of the eye. 
     Referring to  FIG.  23   , a multi-weave embodiment of a portion of wicking portion  204  is depicted as implanted between the conjunctiva and sclera of the eye. A less dense weave structure allows more structural support to prevent the wicking portion  204  from collapsing as the conjunctival heals and contracts overtop. The dense weave structure allows for more surface area to enhance aqueous drainage. 
     An embodiment of a multi-weave aqueous wicking device  200  is depicted in  FIG.  24   . Similar to the other embodiments described herein, aqueous wicking device  200  comprises tube  202  and wicking portion  204 . In this embodiment, wicking portion  204  is a multi-weave-type device that includes thick weave, large-diameter fiber portion  204   a , and fine weave, small-diameter fiber portions  204   b . The thicker weaver and larger fibers of  204   a  provide structural support to prevent contracting tissues from collapsing the finer weave portions  204   b . The finer weave of smaller fibers,  204   b , provides more surface area for maximum aqueous absorption. 
     In an embodiment, and as depicted, thick weave, large-diameter fiber portion  204   a  may include multiple strands  205  extending longitudinally about an exterior portion of wicking portion  204 . In other embodiments, portion  204   a  may also include, or alternatively comprise, latitudinally-extending strands  205 . In an embodiment, thick weave, large-diameter fiber portion  204   a  may include a strand  205  underneath some of fine weave, small-diameter fiber portions  204   b  so as to provide additional structure support to wicking portion  204 . 
     Methods of the invention include making an incision and creating a capsule between the conjunctive and sclera, and inserting wicking portion  204  and all or a portion of tube  202  into the capsule created. Areas underneath the conjunctival/Tenon&#39;s incision are watertight to reduce risk or early wound leakage. 
     In this particular embodiment, wicking portion  204  is a multi-weave embodiment that includes an exterior large-weave portion and in interior fine-weave portion, though it will be understood that a single-weave material embodiment of wicking portion  204  may also be used, and also implanted between the conjunctive and sclera. 
     With the multi-weave, multi-layer embodiment depicted, the fine weave located closer to the interior of the eye may have a tighter weave of smaller fibers to as to create a stronger capillary action, or a higher surface area to aqueous movement. Further making a superficial or outer portion of wicking portion  204  of relatively larger woven fibers provides additional structural strength and prevents unwanted compression of wicking portion  204 . This can be important because as the conjunctiva heals around the glaucoma device, the conjunctival tissues contract. Without the woven material, the healing conjunctiva would seal off the outflow portion of the tube, and the surgery would fail. 
     Methods of the invention described herein include implanting aqueous wicking device  200  in the human eye. For example, referring specifically to  FIG.  25   , an embodiment of aqueous wicking device  200  implanted in an eye is depicted, with the conjunctiva of the eye not shown for illustrative purposes. 
     A method for implanting aqueous wicking device  200  includes the following steps. Either a fornix-based or limbal-based incision is used to dissect conjunctiva and Tenon&#39;s from sclera. The aqueous wicking device is fixated onto the sclera approximately 2-4 mm posterior to the limbus. Access to the anterior chamber is created through a number of methods. A needle/blade ranging from approximate caliber  30 G- 20 G tunnels through the sclera and enters the anterior chamber. The wicking device is inserted into this tunnel and this tunnel fixates the wicking device to the sclera. Conjunctiva/Tenon&#39;s is further dissected as posteriorly as possible. The distal portion of the wicking device is placed in this space and the wicking device is secured to the sclera with barbs  220  to contact, and possibly pierce, portions of the sclera. The second method for the wicking device to access the anterior chamber is to fashion a trabeculectomy-style scleral flap, approximately 3 mm×3 mm, and creating an ostomy between the anterior chamber and the subconjunctival space. The scleral flap is tied down to restrict flow with 10-0 nylon sutures. The anterior portion of the wicking device can be implanted either within the scleral flap, or just posterior to the scleral flap. The third option is to insert the anterior end  210  of tube  202  through the incision and into the anterior chamber, and having the aqueous flow into the aqueous wicking device. 
     Still referring to  FIG.  25   , aqueous wicking device  200  is depicted in cross section as implanted in the eye. As described above, after implantation, anterior end  207  of tube  202  is positioned in the anterior chamber, and thusly in fluid communication with the aqueous humor or aqueous in the anterior chamber of the eye. In an embodiment, an end of wicking portion  204  is placed approximately 5 mm posterior to the limbus. The capillary action of wicking portion  204  draws aqueous out of the anterior chamber, through tube  202  and into the wicking portion  204 , including into cavity  208 , where the aqueous is filtered by the wicking portion  204  and released to other portions of the eye, including the conjunctiva and sclera. 
     Wicking portion  204  functions as a replaceable microfilter membrane, sequestering proinflammatory cytokines and proteins/factors from the aqueous so that that the fluid that reaches the conjunctiva/Tenon&#39;s/Episclera is minimally pro-inflammatory. In other words, the filtered aqueous is similar to a balanced salt solution. This reduces the amount of scarring around the capsule that surrounds the reservoir, or wicking portion  204 , and also ensures a stable postoperative IOP in the target range. Another embodiment is that the woven material itself acts as a sink to sequester proinflammatory mediators and cytokines for a period (lasting hours to weeks) that allow the cytokines to break down before having a chance to interact with the surrounding tissues and induce excessive scarring. The woven material could be composed of or coated with hydrogels, which are materials that trap/sequester cytokines. 
     Further, wicking portion  204  with its filtering function can also serve as a depot for slow release medications or therapeutics that modulate wound healing, inhibit fibrosis and fibroblast transdifferentiation into myofibroblasts. Other slow release medications can also control vascular tone of the post trabecular outflow system (i.e. episcleral venous tone) and enhance uveoscleral outflow of aqueous. 
     Wicking portion  204  can be surgically accessed and replaced numerous times of the course of the patient&#39;s lifetime. 
     Referring to  FIGS.  26 - 28   , another embodiment of aqueous wicking system  200  is depicted. System  200  as depicted in  FIGS.  26 - 28    is substantially similar to the embodiments described above, with the primary exception being that wicking portion  204  is in direct fluid communication with the anterior chamber, rather than a tube  202 . In other words, in the embodiments of  FIGS.  26 - 28   , aqueous wicking system  200  does not include tube  202 , and instead, relies on an end of wicking portion  204  to function as the flow restriction component. 
     Referring specifically to  FIGS.  26  and  27   , an embodiment of a tubeless version of aqueous wicking system  200  is depicted. Wicking portion  204  may be substantially described above with respect to  FIGS.  19 - 23   . In this embodiment, incision  222 , which may be a fornix- or limbal-based incision, is made to fashion a scleral flap  224 . An ostomy is made, anterior end  210  of wicking portion  204  is inserted into the anterior chamber of the eye. The remaining portion, including distal portion  212  of wicking portion  204  is implanted as described above between the conjunctiva and sclera. Flow restriction is performed by suturing the scleral flap to the scleral bed. 
     Aqueous flow volume is determined in part by wicking properties of the size and cross section of that portion of wicking portion  204  that is inserted into the anterior chamber. 
     An advantage of this arrangement is that it creates an artificial trabecular meshwork or filter that is unlikely to be obstructed by blood and/or fibrin. As such this embodiment may present some advantages over an embodiment employing a microshunt or tube  202 . Further, since only a small volume of wicking portion  204  need be inserted into the anterior chamber to produce a large amount of surface area, wicking portion  204  need only be placed a short distance into the anterior chamber and thereby kept away from the endothelium and iris. 
     Referring now to  FIG.  28   , an alternate embodiment of implantable aqueous wicking device  200  is depicted. As briefly described above, wicking portion  204  may comprise various shapes and configurations. In the embodiment depicted in  FIG.  28   , wicking portion  204  includes central strip  204   a  as well as a pair of auxiliary wicking portions  204   b . Auxiliary wicking portions  204   b  as depicted are coupled to central strip  204   a  and extend transversely from strip  204   a  and add additional wicking capacity to wicking portion  204 . In an embodiment, portions  204   b  may comprise the same material and capacity as central strip  204   a , but in other embodiments, may comprise a different material that has more or less wicking capacity, i.e., capillary action. In this embodiment, the capillary action of wicking portion  204  may be increased incrementally by adding various sizes of auxiliary portions  204   b.    
     As described above, with respect to  FIGS.  19 - 28   , the multiple embodiments of wicking device  200  create a capillary action to draw aqueous from the anterior chamber of the eye, followed by filtration by wicking portion  204  prior to release into other areas of the eye, including the conjunctiva and sclera. Wicking portion  204  can sequester or remove pro-inflammatory cytokines and proteins. As described, the woven materials, including fibers, of wicking portion  204  act as a sink to sequester pro-inflammatory mediators and cytokines, allowing the cytokines to break down in, on, or within wicking portion  204 . The use of hydrogels may aid in capturing cytokines. 
     As described above, embodiments of wicking portion  204  may be sorbent, absorptive and/or adsorptive. With an absorptive wicking portion  204 , the aqueous is substantially soaked up or absorbed into wicking portion  204 , which may include absorption of aqueous by materials and coatings of wicking portion  204 , including its woven fibers. This absorption effect not only creates the capillary effect, but also aids in the sequestering of pro-inflammatory cytokines. 
     Embodiments of wicking device  200 , including those described above with respect to  FIGS.  19 - 28    may be configured to specifically include adsorptive properties, in addition to, or in some embodiments, rather than, the absorptive properties described above, so as to further enhance the removal of certain cytokines from the aqueous. As one of ordinary skill will understand, in an adsorption process, atoms, ions or molecules of the aqueous are retained onto a surface of an adsorbent. 
     Glaucoma patients with high IOPs may also have significant amounts of pro-inflammatory cytokines in their aqueous, as compared to patients without glaucoma, as described in “Pro-Inflammatory Cytokines in Glaucomatous Aqueous and Encysted Molteno Implant Blebs and Their Relationship to Pressure”, Jeffrey Freedman and Pavel Iserovich as published July 2013, in Volume 54, Issue 7 of Investigative Ophthalmology &amp; Visual Science, which is incorporated herein by reference in its entirety. Certain cytokines may cause changes in the cells of the trabecular meshwork, resulting in a decrease in aqueous outflow, thereby causing an elevation in IOP. The removal of such pro-inflammatory cytokines may reduce IOP as part of a glaucoma treatment. 
     According to embodiments of the invention, aqueous filtering or purification using adsorption may be particularly effective in removing or sequestering cytokines and so reducing IOP and treating glaucoma. Such embodiments, may include adsorptive wicking devices  200 , or other devices and techniques adapted to utilize adsorption to remove or sequester cytokines. 
     Referring generally to  FIGS.  29 - 32   , wicking device  200  may be configured to include cytokine adsorpters, such that wicking device  200  comprises an implantable adsorptive filtering device for aqueous purification and glaucoma filtration surgery. 
     Referring specifically to  FIG.  29   , depicted wicking device  200  is substantially the same as wicking device  200  depicted in  FIG.  25   , which depicts a sectional view of wicking device  200  implanted into an eye, with the exception that the wicking device  200  of  FIG.  29    includes a plurality of cytokine-adsorptive micro-beads  300 . Similar to the embodiment of  FIG.  25   , wicking device  200  of  FIG.  29    includes tube  202  with anterior end  207  in communication with the anterior chamber of the eye. Wicking portion  204  defines cavity  208 , which receives posterior end  209 , thereby connecting the aqueous-filled anterior chamber with cavity  208 , such that aqueous flows from the anterior chamber into cavity  208  via tube  202  due to the pressure in the anterior chamber and the capillary forces created by wicking portion  204 . 
     In this embodiment, cavity  208  includes the plurality of cytokine-adsorptive micro-beads  300 . As depicted, cavity  208  may be entirely or substantially filled with cytokine-adsorptive-micro-beads in a tightly-packed pattern. In such an embodiment, aqueous will fill the spaces around cytokine-adsorptive micro-beads  300 . In other embodiments, cavity  208  may not be substantially filled with cytokine-adsorptive micro-beads  300 , so as to leave a larger volume to be filled with aqueous, thereby accommodating a relatively higher flow of aqueous. 
     After implantation, aqueous flows into cavity  208 , bringing aqueous into contact with surfaces of cytokine-adsorptive micro-beads  300 . As described further below, cytokine-adsorptive micro-beads  300  will adhere to the surfaces of cytokine-adsorptive micro-beads  300 , thereby removing the cytokines from the aqueous and retaining them within wicking device  200 . The filtered aqueous flows out of wicking portion  204  to other parts of the eye, and cytokines remain within wicking device  200 , adhered to surfaces of cytokine-adsorptive micro-beads  300 . 
     Referring also to  FIG.  30   , another embodiment of a cytokine-adsorbent wicking device  200  that functions as an adsorptive filtering device, is depicted. In this embodiment, wicking device  200  is substantially similar to the embodiment of wicking device  200  of  FIG.  19   , but with the addition of cytokine-adsorptive micro-beads  300  in cavity  208  of wicking portion  204 . 
     In an embodiment, cytokine-adsorptive micro-beads  300  comprise small beads that may be made of a biocompatible polymer material. In another embodiment, cytokine-adsorptive micro-beads  300  may comprise resins, or macro-porous resins. In an embodiment, cytokine-adsorptive micro-beads  300  are sized such that many, perhaps hundreds, of cytokine-adsorptive micro-beads  300  will fit in cavity  208 . In an embodiment, cytokine-adsorptive micro-beads  300  are similar in size to a grain of salt, or approximately 0.3 mm in diameter. In an embodiment, a diameter of cytokine-adsorptive micro-beads  300  ranges from 0.2 mm to 0.4 mm. In other embodiments, cytokine-adsorptive micro-beads  300  are larger or smaller. In an embodiment, a diameter of beads  300  ranges from 0.3 mm to 1.5 mm; in another embodiment, a diameter of beads  300  ranges from 0.6 mm to 1.2 mm. 
     In an embodiment, the surface of the biocompatible cytokine-adsorptive micro-beads  300  may be porous, having pores sized to trap and retain smaller cytokines, which generally are hydrophobic, while allowing larger components such as red blood cells to pass between the beads. Pore size may be relative constant for each bead  300  so as to target a particular cytokine, or may vary in size for each bead  300  so each bead is capable of adhering to adhere to multiple sizes and types of cytokines. 
     In an embodiment, cytokine-adsorptive micro-beads  300  may be mixed with hydrogels in cavity  208  to enhance the capture of cytokines, many of which are known to be hydrophobic. 
     As described above, the removal or sequestering of pro-inflammatory cytokines may decrease inflammation and subsequently IOP. Embodiments of wicking device  200  may be configured to filter particular pro-inflammatory cytokines, such as CXLCL 1 , CCL 2 , CXCL 5 ,  3 , and  4 ; and TGF-02, through the use of specifically-configured beads using pore sizing and shaping, and particular coatings or hydrogels to trap and retain targeted cytokines. 
     In an embodiment, cytokine-adsorptive micro-beads  300  may comprise CytoSorb© beads, as produced by CytoSorbents Corporation of Monmouth Junction, N.J., USA, marketed for use in blood filtering. 
     In other embodiments, rather than utilizing cytokine-adsorptive micro-beads  300 , the fibers of wicking portion  204  may be coated with adsorbent or hydrogel substances, or the fibers themselves may include pores of a size to retain cytokines. 
     In the embodiments described above, cytokine-adsorptive micro-beads  300  may be inserted directly into wicking portions  204  of wicking device  200 . However, in other embodiments, wicking device  200  may include a separate cytokine-adsorption device  302 , as depicted in  FIGS.  31 - 32   , which may form aqueous filtering system  304  comprising wicking device  200  and cytokine-adsorption device  302 . 
     Referring specifically to  FIG.  31   , an embodiment of cytokine-adsorption device  302  is depicted. In the depicted embodiment, cytokine-adsorption device  302  includes housing  306 , inlet  308 , outlet  310  and defines cavity  312 . Cavity  312  includes a plurality of cytokine-adsorptive micro-beads  300  (dashed lines), having the composition and properties described above. In an embodiment, cytokine-adsorptive micro-beads  300  may be mixed in with a hydrogel in cavity  312 . 
     In an embodiment, housing  306  may comprise a relatively rigid, though biocompatible structure, comprised of a polymer or resin material, and configured to be implanted in the eye. In such an embodiment, aqueous will flow in via inlet  308 , and out via outlet  310 . In such an embodiment, cytokine-adsorption device  302  may comprise an assembled biocaompatible cartridge. In an embodiment, housing  306  may form a generally cylindrical shape, though other shapes are contemplated. 
     In other embodiments, housing  306  may comprise a flexible material, similar to a sack or pouch, but still having an inlet  308  and an outlet  310 . In one such embodiment, housing  306  may comprise a membranous material that allows some filtered aqueous or other molecules to flow out through the membrane that is housing  306 , and to portions of the eye, such as the conjunctiva and sclera. 
     Referring also to  FIG.  32   , as depicted, inlet  308  may comprise a tube-like structure defining an inlet channel, and outlet  310  may also comprise a tube-like structure defining an outlet channel. Inlet  308  may be configured to attach to tube portion  202   a , or may be long enough have an end that is directed inserted into the anterior chamber of the eye. Outlet  310  may be configured to attach to tube portion  202   b  of wicking device  200 . In other embodiments, inlet  308  and outlet  310  may simply be openings in housing  306  configured to receive portions of tube  202 , which may include tube portion  202   a  and  202   b , respectively. 
     Referring specifically to  FIG.  32   , in an embodiment, cytokine-adsorption device  302  at its inlet is connected to tube portion  202   a  of tube  202 , which is in fluid communication with the anterior chamber of the eye. Outlet  310  of cytokine-adsorption device  302  is connected to tube portion  202   b , so as to be in fluid communication with wicking device  200 , including cavity  208  of wicking portion  204 . 
     In operation, the woven fibers of wicking portion  204  create capillary forces that draw aqueous from the anterior chamber, through tube portion  202   a , and into cavity  312 . The aqueous contacts surfaces of cytokine-adsorptive micro-beads  300 , and through the adsorption process described above, binds cytokines to cytokine-adsorptive micro-beads  300 , thusly filtering out cytokines in a first-stage filtering process. 
     Aqueous then flows out of cytokine-adsorption device  302 , which may also be referred to as a first-stage filter or filtering device, through tube portion  202   b , and into cavity  208  of wicking portion  204 . Wicking portion  204  not only provides the capillary forces to draw the aqueous out of the anterior chamber and into cytokine-adsorption device  302  and wicking device  200 , but also acts as a second-stage filtering device. The fibers of wicking portion  204  may further filter out and retain cytokines not trapped by beads  300 , or may filter and retain types of cytokines not meant to be filtered out by beads  300 . Wicking portion  204  and its cavity  312  may also include medications and/or therapeutics to be absorbed into the aqueous. 
     After being received by wicking device  200  and being subjected to second-stage filtering, the aqueous flows out of wicking portion  204  and into the eye, which may include flowing into the sclera of the eye. 
     While aqueous filtering system  304  may include both wicking device  200  and cytokine-adsorption device  302  in combination, or a adsorbent wicking device  200  with adsorptive beads or other adsorptive materials, cytokine-adsorption device  302  may also be used independently, without wicking device  200 , as a stand-alone filtering device, or as part of another glaucoma treatment solution. 
     In addition to the embodiments of cytokine-adsorption device  302  described above, other embodiments may utilize adsorption to filter out, remove or sequester cytokines. 
     In one such embodiment, a cytokine-adsorption device  302  includes housing  306  in the form of a membrane, as described in part above. In one such embodiment, the membrane itself may be an adsorptive membrane. In one such an embodiment, membrane  306  may be a single or multi-layer membrane made of a polymer material. Some or all layers being adsorbent of pro-inflammatory cytokines. Adsorbtion of cytokines may be accomplished through the use of a combination of hydrophobic and hydrophilic materials to selectively bind either hydrophobic or hydrophilic cytokines. 
     In an embodiment, cytokine-adsorption device  302  comprising a membranous housing, or membrane  306 , may be rolled or folded to be inserted through small incisions in the eye, independent of wicking device  200 . Such membranous devices  302  may include adsorbent membranous layers and/or may include adsorbent materials, such as beads  300 , within cavities formed by the membrane  306 . 
     Cytokine-adsorption device  302 , including membranous embodiments thereof, could be implanted for short-term use, and in some cases, after the effectiveness of the device  302  is past its peak, and after the device has degraded over time and with use, the device could be exchanged with a fresh membrane after a predetermined period of time. In other words, cytokine-adsorption device  302  could be a short-term temporary implant. 
     However, in other embodiments, cytokine-adsorption device  302  could be a permanent implant, particularly for embodiments having a longer-lasting housing  306 . 
     In yet other embodiments, cytokine-adsorption device  302  could be replenished with adsorbent material, either through injection of new material, or by removal and exchange of adsorbent material. 
     In another embodiment, rather than cytokine-adsorptive micro-beads  300 , cytokine-adsorption device  302  or wicking device  200 , may include other types of materials, such as fibers or meshes having coatings. 
     In some embodiments, adsorbent materials, such as beads  300  or adsorbent resins could be injected directly into the subconjunctival space. In an embodiment, such adsorbent, cytokine-attracting resins would have sufficient plasticity to be biomechanically compatible with the surrounding tissue. A mixture of an injectable hydrogel with beads  300  could also be used. The hydrogel would prevent the migration of the beads into unwanted areas. 
     In other embodiments, aqueous filter of cytokines could be accomplished using electrochemical means. Another embodiment is that the adsorbent materials may slowly be absorbed overtime and may need to be periodically replenished with repeat injections of adsorbent materials into the subconjunctival space. 
     This application also applies to the concept of using the above technologies to purify cytokines from bodily fluids/organs within the human body, such as synovial fluid within joints in orthopedic and interstitial fluid during wound healing. This approach could also potentially be used in oncology for treating areas of smoldering inflammation to prevent tumorigenesis. Also, this technology could be injected within and or surrounding tumor around the time of radiotherapy/immunotherapy/chemotherapy to reduce the risk of cytokine storm during oncology treatment and surgery. 
     The following United States patents are hereby incorporated by reference herein: U.S. Pat. Nos. U.S. Pat. Nos. 9,113,843, 9,220,834, 9,241,641, 9,333,293, 9,352,105, and 9,457,140. The above references to U.S. patents in all sections of this application are herein incorporated by references in their entirety for all purposes. Components illustrated in such patents may be utilized with embodiments herein. Incorporation by reference is discussed, for example, in MPEP section 2163.07(B). 
     All of the features disclosed in this specification (including the references incorporated by reference, including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. 
     Each feature disclosed in this specification (including references incorporated by reference, any accompanying claims, abstract and drawings) may be replaced by alternative features serving the same, equivalent or similar purpose, unless expressly stated otherwise. Thus, unless expressly stated otherwise, each feature disclosed is one example only of a generic series of equivalent or similar features. 
     The invention is not restricted to the details of the foregoing embodiment(s). The invention extends to any novel one, or any novel combination, of the features disclosed in this specification (including any incorporated by reference references, any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed The above references in all sections of this application are herein incorporated by references in their entirety for all purposes. 
     Although specific examples have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that any arrangement calculated to achieve the same purpose could be substituted for the specific examples shown. This application is intended to cover adaptations or variations of the present subject matter. Therefore, it is intended that the invention be defined by the attached claims and their legal equivalents, as well as the following illustrative aspects. The above described aspects embodiments of the invention are merely descriptive of its principles and are not to be considered limiting. Further modifications of the invention herein disclosed will occur to those skilled in the respective arts and all such modifications are deemed to be within the scope of the invention.