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The use of intraluminal PRESERFLO stenting in avoiding early postoperative hypotony
Raoul Verma-Fuehring1, Mohamad Dakroub1, Ahmed Bamousa1
1Department of Ophthalmology, University Hospital Würzburg (UKW), Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
Purpose:
Postoperative hypotony following PRESERFLO MicroShunt (PMS) implantation is a frequent cause of complications such as choroidal detachment and hypotony maculopathy. This study aims at evaluating the impact of intraluminal stenting of the PMS during the early postoperative period.
Methods:
We retrospectively analyzed the data of 97 patients who underwent PMS implantation with intraoperative placement of a Nylon 10-0 suture as intraluminal stent (PStent) and compared the outcomes to those of an existing database of the traditional MicroShunt implantation technique (PTrad, n = 120). The primary outcome measure was the intraocular pressure (IOP) at one week postoperatively. As a secondary outcome measure, adverse hypotony, defined as an IOP ≤ 5 mmHg with significant choroidal effusion and/or anterior chamber shallowing or the presence of macular folds was also assessed. Additionally, the time to stent removal and the IOP one week after stent removal were reported.
Results:
Preoperative median IOP was 25.0 (20.5-30.3) mmHg in PStent and 25.0 (19.3-32.0) mmHg in PTrad (p = 0.62). One week after surgery, the median IOP dropped to 10.0 (8.0-13.0) mmHg in PStent and 7.0 (5.0-9.0) in PTrad (p < 0.01). At one month, the IOP was 12.0 (10.0-14.0) mmHg in PStent and 10.0 (8.0-11.0) mmHg in PTrad (p < 0.01). After 3 months, both groups showed similar median IOP levels of 11.0 (8.0-13.5) mmHg and 10.0 (9.75-13.0) mmHg in PStent and PTrad, respectively (p = 0.66). The presence of adverse hypotony was significantly lower in PStent compared to PTrad (6.2% vs 15.8%, p < 0.05). In PStent the stent was removed after 30.0 (21.0-42.5) days. One week after stent removal the mean IOP drop was 6.1 ± 0.5 mmHg (p < 0.01).
Conclusion:
In the early follow-up period, intraluminal stenting of the PMS appears to be safe and effective in controlling the IOP while reducing early postoperative hypotony. Surgical success is not compromised by stent placement. Based on our data, it is recommended to remove the suture two to six weeks after surgery for most patients with uncomplicated postoperative clinical findings.
Insights
Intraluminal stenting of the PRESERFLO MicroShunt (PMS) effectively controls early postoperative intraocular pressure (IOP) and reduces hypotony complications. Stent removal at 2-6 weeks is recommended for most patients.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Innovation
Background:
- Postoperative hypotony is a common complication following PRESERFLO MicroShunt (PMS) implantation, leading to issues like choroidal detachment.
- Managing early postoperative intraocular pressure (IOP) is crucial for preventing adverse outcomes after glaucoma surgery.
Purpose of the Study:
- To evaluate the impact of intraluminal stenting of the PMS during the early postoperative period.
- To assess the safety and efficacy of temporary intraluminal stenting in mitigating hypotony after PMS implantation.
Main Methods:
- Retrospective analysis of 97 patients undergoing PMS implantation with an intraluminal stent (PStent) compared to 120 patients with traditional PMS implantation (PTrad).
- Primary outcome: IOP at one week postoperatively. Secondary outcomes: incidence of adverse hypotony, time to stent removal, and IOP post-removal.
Main Results:
- The PStent group showed a significantly lower incidence of adverse hypotony (6.2% vs. 15.8%, p<0.05) compared to the PTrad group.
- While initial IOP was lower in PTrad at one week (7.0 mmHg vs. 10.0 mmHg, p<0.01), IOP levels became comparable by three months.
- Stent removal occurred at a median of 30 days, with a significant IOP drop observed one week after removal.
Conclusions:
- Intraluminal stenting of the PMS is a safe and effective method for controlling IOP and reducing early postoperative hypotony.
- Surgical success with PMS implantation is not compromised by the use of an intraluminal stent.
- A recommended stent removal window of two to six weeks post-surgery is suggested for patients with uncomplicated outcomes.
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