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PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature
Jérôme George1, Hana Abouzeid1
1Ophthalmology, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
Abstract:
The PRESERFLO™ MicroShunt (MP; Santen Inc., Osaka, Japan) is a minimally invasive bleb surgery (MIBS) manufactured to treat primary open-angle glaucoma (POAG), with lower postoperative adverse effects than with conventional filtering surgeries. We describe here the case study of a 58-year-old woman who presented with bilateral severe myopia with bilateral advanced POAG and unreached target pressure under quadritherapy, who was successfully managed by PM surgery. A review of the literature completes our observation. At presentation, the patient had a spherical equivalent of - 7.50 RE and - 7.75 LE with an IOP of 22 mmHg right and left eye (RLE) under quadritherapy, and with severe bilateral visual field loss, including scotomas within the central 5°. The patient presented with systemic hypertension treated with an antihypertensive drug. Two selective laser trabeculoplasties (SLT), performed 3 months apart, were first tried on the LE, without any change in IOP at 2 months. After considering the high risk of postoperative complications, a PM operation was proposed, with a targeted IOP in the mid-fifteens RLE. The patient's eyes underwent PM surgery with mitomycin C (MMC) MMC0.2 mg/mL for 3 minutes without any complications. The LE required 2 consecutive needlings with 1 mL MMC0.2 mg/mL. At 24 months after surgery, the two eyes gave successful results without the need for any additional medical therapy, and with well-functioning conjunctival blebs. The PM was an effective alternative to the gold standard trabeculectomy in our severely myopic patient. A comparative study between conventional filtering operations and this MIBS in highly myopic patients would confirm our observation.
Insights
The PRESERFLO™ MicroShunt effectively managed advanced primary open-angle glaucoma in a highly myopic patient. This minimally invasive surgery offered a successful alternative to traditional procedures, achieving target intraocular pressure without additional medication.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Minimally Invasive Surgery
Background:
- Primary open-angle glaucoma (POAG) management often requires advanced surgical interventions for refractory cases.
- High myopia presents unique challenges in glaucoma treatment due to anatomical and physiological differences.
- Conventional filtering surgeries carry risks, necessitating exploration of safer alternatives.
Purpose of the Study:
- To report a case study of successful management of advanced POAG in a severely myopic patient using the PRESERFLO™ MicroShunt.
- To evaluate the efficacy and safety of the PRESERFLO™ MicroShunt as a minimally invasive glaucoma surgery (MIBS) in a complex case.
- To review the literature on MIBS for glaucoma in highly myopic patients.
Main Methods:
- A 58-year-old female patient with bilateral severe myopia and advanced POAG, uncontrolled on quadritherapy, was treated.
- PRESERFLO™ MicroShunt surgery was performed bilaterally with mitomycin C (MMC).
- The patient underwent two consecutive needlings on the left eye post-surgery.
Main Results:
- The PRESERFLO™ MicroShunt surgery was technically successful without immediate complications.
- At 24 months post-surgery, the patient achieved target intraocular pressure in both eyes without additional medical therapy.
- Well-functioning conjunctival blebs were observed, indicating successful surgical outcomes.
Conclusions:
- The PRESERFLO™ MicroShunt is an effective alternative to trabeculectomy for managing advanced POAG in highly myopic patients.
- Minimally invasive glaucoma surgery demonstrates potential for favorable outcomes in complex glaucoma cases.
- Further comparative studies are warranted to confirm the efficacy of MIBS in highly myopic populations.
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