Efficacy and safety of preserflo™ microshunt in refractory ocular hypertension with or without secondary glaucoma following pars plana vitrectomy.

PURPOSE

To evaluate the Preserflo™ MicroShunt, a minimally invasive glaucoma surgery (MIGS) device, as an alternative for managing intraocular pressure (IOP) in patients with refractory ocular hypertension or secondary glaucoma following pars plana vitrectomy (PPV).

METHODS

This retrospective observational study included adult patients with refractory ocular hypertension after PPV, defined as persistent elevated IOP despite maximal medical therapy, with or without secondary glaucoma (defined as glaucomatous changes developing after PPV). Patients with pre-existing glaucoma prior to PPV were excluded. Preserflo™ MicroShunt implantation was performed to manage IOP. The primary outcome was a ≥ 30% IOP reduction from baseline with IOP ≤ 21 mmHg at six months. Secondary outcomes included IOP changes at various postoperative intervals, need for hypotensive medications, and surgical bleb revisions.

RESULTS

Twenty-five eyes from 25 patients were included, with a minimum follow-up of six months (88% had 12-month follow-up). Mean preoperative IOP was 29.7 mmHg, decreasing to 14.8 mmHg at six months and 14.0 mmHg at twelve months, representing reductions of 50.2% and 52.3%, respectively. At six months, 92% of patients met the success criteria. In the subgroup of patients with prior retinal detachment and silicone oil tamponade (one patient with oil in situ; the remaining 11 had oil removed at least six months before Preserflo™ MicroShunt implantation), mean IOP decreased by 65% (from 30.4 mmHg to 10.7 mmHg). Surgical bleb revision was required in 40% of cases. Only one case of hypotony (4%) occurred, which resolved without complications. No serious adverse events were reported.

CONCLUSION

The Preserflo™ MicroShunt appears to be a safe and effective option for managing refractory ocular hypertension or secondary glaucoma following PPV, demonstrating significant IOP reduction and a favorable safety profile. Further prospective studies are warranted to confirm these findings and optimize surgical protocols.

KEY MESSAGE

WHAT IS KNOWN

Secondary glaucoma following pars plana vitrectomy (PPV) is challenging to manage, and traditional surgeries such as trabeculectomy show limited success in these eyes. The Preserflo™ MicroShunt has shown promise in primary open-angle glaucoma, but data in vitrectomized eyes are limited.

WHAT THIS STUDY ADDS

Preserflo™ MicroShunt is effective and safe in refractory ocular hypertension or Secondary Glaucoma after PPV, achieving a 50-52% IOP reduction and meeting success criteria in 92% of cases at 6 months It shows excellent efficacy even in complex cases such as glaucoma secondary to prior PPV with silicone oil tamponade, with a 65% IOP reduction, demonstrating its versatility in difficult post-PPV scenarios. Bleb-related complications were more frequent than in primary glaucoma cases but were safely managed through open surgical revisions, suggesting tailored postoperative management is key in this population.