Abstract
Purpose :
Data analysis after surgical revision of PreserFlo® MicroShunt in eyes with open angle glaucoma (OAG)
Methods :
A consecutive series of patients with OAG underwent PreserFlo® MicroShunt implantation (+ MMC 0.4mg/ml for 2 min) between 2019 - 2023 as a primary glaucoma surgery. Intraocular pressure (IOP), visual acuity, biomicroscopy, and number of glaucoma medications were retrospectively collected. Qualified success (QS) / complete success (CS) were defined as IOP ≤18 mmHg or > 30% IOP reduction respectively with or without glaucoma medication. Surgical revision (+ MMC 0.2mg/ml for 2min) was performed when IOP was ≥ 18mmHg or the target IOP was not reached despite maximal therapy. Failure defined when additional glaucoma surgery was needed. The pre-and post-revision IOP, time – laps after primary surgery, risk factors and the post-revision outcome were recorded.
Results :
56 eyes of 49 consecutive patients were analysed and followed for a mean of 36 months (± 12.14). Mean IOP before the Preserflo®Microshunt was 21.88 mmHg (SD 7.44) with a mean of 2.7 medications. At 12 and 48 months (56 and 35 eyes respectively) mean IOP was 12.5 mmHg (SD 3.4) and 11,27mmHg (SD 2.5) respectively. CS occurred in 46%, QS in 93% with a mean of 0.8 medications. Failure occurred in 7%.
Surgical revision was needed in 14 eyes (25%) at a mean of 21.34 months (SD 16.3) after primary surgery. The mean IOP before revision was 23.6 mmHg (SD 7.34). At last visit 9 eyes (64%) were considered CS and one eye QS. Five out of 14 eyes (36%) had axial myopia, five eyes (36%) of four patients were under age of 60, three eyes had Pseudexfoliative glaucoma. 4 eyes (28%) failed after revision needing additional glaucoma surgery at 3, 6, 13 and 24 months (2 high myopic eyes, 2 younger patient).
Conclusions :
The Preserflo® Microshunt provides a significant long term IOP lowering effect. However, when not reaching the desired target IOP, our data, suggest that surgical revision is a valuable approache and allows a high rate of complet success.regardelss of the time-laps after primary microshunt implantation. Only a minority of revisions fail, requiring additional glaucoma surgery. In this relatively small cohort the main risk factor for surgical revision were high myopia and younger age..
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.