referring now to fig4 of the drawings , there is shown a schematic representation of the ophthalmic implant , cylindrical tube 32 , with the proximal end 34 shown on the left and the distal end 36 shown on the right . it is to be noted that tube 32 may be and includes tubes of a cross - sectional shape other than circular , e . g . triangular , rectangular , pentagonal , l - shaped , etc . this is because the capsule formed around the tube when the capsule is inflated will be essentially a cylindrical shape as it is inflated by fluid . in practice , the conjunctiva is incised about 3 mm from the limbus and the conjunctiva is elevated by blunt dissection 10 – 12 mm back so that the longer distal end of the implant can be pushed into the pocket so formed . through this same incision , a needle track is made entering the anterior chamber just in front of the iris . the proximal end 34 is inserted through this needle track 48 , shown in fig3 , made by a 23 gauge needle . the small gauge ensures that limbal tissues adhere to the latex tubing without leakage so that intraocular pressure from aqueous humor can reform the anterior chamber . the tube serves as a permanent conduit for passage of aqueous humor past the angle structures . the distal tubing serves as a nidus for the growth of fibrous , permeable tissue . once elevated from the latex this fibrous tissue forms a filtration capsule that drains aqueous humor into subconjunctival tissue . venting this fluid is controlled by the hydraulic resistance of the capsule and controls intraocular pressure preventing further damage to the optic nerve , which is the characteristic of the disease , glaucoma . the inserted tube may be made of latex or any other suitable , flexible material . flexible material is chosen to prevent erosion of eye tissues in contact with the implant . the proximal end 34 comprises a whole cylindrical portion 46 which is ligated , i . e ., tied off with ligature 44 as shown in fig3 and 7 . the ligatures comprise slip knots for ease of removal after insertion of the implant . it is to be noted that any equivalent to a slip knot which would allow simple opening of a closed off portion could be used . ligature 44 also serves to anchor tube 32 to the sclera at the limbus where the tube enters the anterior chamber through the needle track 48 . as with most surgical intervention , in the early postoperative days , there is a seton effect , where aqueous leakage occurs along the path 48 where the implant 32 enters the anterior chamber . it is during this period that the eye is at risk due to hypotony , i . e ., low pressure and possible retinal detachment . therefore , a newly installed tube is ligated initially , until a proper capsule can grow around the implant . a lesser desired alternative to litigating the tube is use of soluble plug surrounding the tube . the weakest tissue adhesion point in the implant 32 is between the fibrous cellular capsule and the latex tubing . the implant lateral portion 38 is peeled back ( similar to peeling a banana ) or otherwise removed along the open side 40 of the implant to form a nidus for fibrous cell growth along c - shaped cross sections , as shown in fig1 and 16 . once ligature 44 is released , pressurized aqueous will lift the capsule away from the latex tubing and form a bleb 28 . fig1 shows the fibrous capsule 28 prior to release of ligature 44 and fig1 shows the fibrous capsule 28 as inflated after release of ligature 44 . the latex tube remains free - floating within the bleb to prevent constriction , collapse , or adhesions forming inside the bleb . alternatively , the distal tube 32 may be made of dissolvable material which is eventually sloughed off . the proximal portion must remain intact and permanently in place or else the tight limbal tissues will occlude the opening through the angle structures and aqueous passage will be blocked . the tube of the present embodiment is bifurcated at distal end 36 , fig4 . bifurcated portions 32 a and lateral portion 38 may be shaped as shown in fig1 and 16 respectively . bifurcated portions 32 a and lateral portion 38 serve as nidi for fibrous tissue growth 28 as shown in fig1 . after 5 – 7 days the capsule has had sufficient time to form with an appropriate thickness . elevation of the capsule from the implant by pressurized aqueous forms a bleb that filters aqueous into subconjunctival tissues . bifurcated portions 32 a serve as a second anchor after a bleb is formed around these bifurcated portions . thereafter , ligature 50 is released thereby inflating bleb 28 , fig1 , and allowing aqueous to pass from the anterior chamber to subconjunctival tissue . referring to fig5 , the second embodiment reflects a replication of the middle section of the first embodiment of fig4 including ligature 144 tied around intact cylindrical portion 146 . an advantage of the multiple whole cylindrical section 146 and the associated ligatures 144 , 150 , 151 and 152 of the fig5 embodiment of the invention is that the length of the operable implant , i . e . the inflated bleb portion may be increased as required by removing a ligature or plurality of ligatures section - by - section in series by simply removing the ligatures in a manner well - known tone skilled in the art , in this case an ophthalmologist . the present invention offers a post - surgical ability to customize the total surface area of the implant by increasing the functional surface area without the need of further surgery or an additional implant by simply removing a ligature 44 or a series of ligatures 144 , 150 , 151 and / or 152 from the whole cylinder portion ( s ) 146 after post - surgical intraocular pressure has been determined . it can readily be seen by one skilled in the art that the tube may contain any reasonable number of peeled back portions 138 and resulting open sides 140 . fig8 shows a third embodiment of the invention similar in all respects to the first and second embodiments except the distal end 236 in quadricated , i . e . split into four sections 242 rather than two sections 32 a . it can readily be seen by one skilled in the art that the distal end may be split into any reasonable number of sections . the purpose of forming the split end sections 32 a , 242 and the peeled back lateral portions 38 is to allow a greater surface area but minimal total length of bleb . it does not matter that the nidi formed by the split ends become increasingly smaller in cross section . as the number of splits increase , the diameter of the bleb formed will be smaller in diameter and further reduced surface tension on the capsule , resulting in thinner capsule wall . the thickest part of the capsule forming around the c - shaped section 40 , is only approximately three cell is thickness . fig1 – 14 show a fourth embodiment of the invention . this embodiment includes latex scalloped nidus 338 extending from either side of the open - sided , c - shaped section 340 . scalloped nidus 338 may be attached to main body 340 of the implant by any well - known means . a cross section of scalloped nidus 338 is shown in fig1 and 14 . bleb 328 is shown formed around nidus 338 in fig1 . scalloped portion 338 includes central or hub portion 370 and tip portions 372 . scalloped portion 338 has a radius of 50 microns from the center to the outer tip of the scallop , a tip width of 5 microns , and preferably extends up to 20 millimeters in a normal direction from the tube depending upon the requirements determined by the attending ophthalmologist . the advantage of the scalloped geometry is that , if the capsule or bleb is deposited onto a smooth , solid surface , pressure from the anterior chamber may not always be sufficient to separate the capsule from the smooth , solid surface and inflate a volume in the subconjunctival space . if a bleb does not form or if the capsule remains attached to the implant material , it will not vent fluid and will not become functional . the number of scallops is a matter of choice , however 3 , 4 , 5 , or 6 scallops is a reasonable number . likewise , other forms providing a wave - like perimeter , such that the length of the perimeter is greater than the diameter of the form multiplied by pi , are within the scope of the present invention . the method of the present invention for reducing intraocular pressure by creating a cylindrical bleb for producing improved accessory filtration comprises the steps of implanting a cylindrical tube having a proximal end and distal end , the distal portion of the cylindrical tube side wall being removed , into an eye to serve as a nidus for a conduit of aqueous humor to bypass angle structures consists of the steps of implanting the distal portion of the cylindrical tube under the conjunctiva , anchoring the proximal end of the cylindrical tube to the limbus , inserting the proximal , intact end of the tube into the anterior chamber through a needle track , ligating the distal end to prevent hypotony , allowing approximately one week for a bleb to grow around the tube , releasing a ligature around the proximal end after approximately one week to inflate the bleb , measuring the intraocular pressure to determine if additional drainage is required , if additional drainage is required , releasing additional ligatures whereby additional blebs are inflated . those with skill in the art of surgical treatment of glaucoma will readily see the invention &# 39 ; s simplicity and flexibility . thus the reader will see that the implant and method of reducing intraocular pressure of the present invention provides a more effective and customizable , yet economical solution for reduction of intraocular pressure . while the above description contains many specificities , these should not be construed as limitations of the scope of the invention , but rather as an exemplification of preferred embodiments thereof . many other variations are possible . for example , the material of the insert may be made of many types of elastomers other than latex ; the size of the needle may be other than 23 gauge ; the size , number , shape and dimensions of nidi and slip knot ligatures may vary and is not limited to four or to a “ c ” shape ; the open diameter of the implant could vary ; and the shape of the implant could be other than circular in cross section . the term “ slip knot ” as used here and in the claims includes any releasable knot . accordingly , the scope of the invention should be determined not by the embodiments illustrated , but by the appended claims and their legal equivalents .
a tube for implantation into the eye for replacement conduction of aqueous humor from the chambers of the eyeball to the subconjunctival tissue and ultimately to the venous system is comprised of an elongated fluid conducting conduit having distal and proximate ends , a sidewall and an interior passageway and at least one longitudinally extending opening in the sidewall that exposes the interior passageway and at least one nidi - forming structure carried by the conduit and extending laterally therefrom to implement the formation of at least one aqueous filtration bleb in the tissue of the eyeball . in one embodiment , the tube also contains at least one releasable ligature circumscribing the conduit . in another embodiment , the tube also contains an anchor appended to the conduit to prevent it from migrating from its placement site .