PreserFlo MicroShunt versus trabeculectomy: an updated meta-analysis and systematic review

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma management often involves surgical intervention to control intraocular pressure (IOP).
• PreserFlo (PF) and trabeculectomy (TB) are surgical options, but their comparative effectiveness, particularly in moderate-to-advanced glaucoma, requires further elucidation.
• Existing data presents a contentious landscape regarding the optimal surgical approach between PF and TB.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of PreserFlo MicroShunt (PF) and trabeculectomy (TB) in patients with moderate-to-advanced glaucoma.
• To evaluate key outcomes including success rates, intraocular pressure (IOP) reduction, complications, reinterventions, and visual field progression.
• To provide evidence-based insights into the comparative benefits and risks of PF versus TB for glaucoma treatment.

Main Methods:

• A systematic literature search was performed across PubMed, Scopus, and Cochrane Central databases up to January 13, 2024.
• Included studies were randomized and non-randomized trials with a minimum follow-up period of 2 months.
• Risk of bias was assessed using ROB-2 for RCTs and ROBIN-I for non-RCTs, with publication bias evaluated using funnel plots and Egger's regression.

Main Results:

• Ten studies involving 1833 eyes were analyzed, with 57.4% undergoing PF.
• No significant differences in qualified or complete success rates were observed between PF and TB.
• TB demonstrated superior IOP reduction (MD -2.52 mmHg) and better IOP outcomes (MD 1.59 mmHg). PF showed less visual field progression (MD -1.21) and a lower risk of hypotony maculopathy (OR 0.30).
• PF exhibited a higher reintervention rate, particularly in patients without prior glaucoma surgery or with primary open-angle glaucoma.

Conclusions:

• Trabeculectomy (TB) is more effective for uncontrolled glaucoma up to 2 years, especially when targeting lower IOPs.
• PreserFlo (PF) offers a lower risk of hypotony-related events and may be advantageous for patients sensitive to visual field loss.
• PF is associated with a higher reintervention rate, particularly in specific patient subgroups, highlighting the need for individualized surgical decision-making.