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Updated: Jun 7, 2025
Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
Published on: September 20, 2024
Transient hyphema associated with PRESERFLO® MicroShunt surgery using a double-step knife in patients with glaucoma
Rei Sakata1,2,3, Makoto Aihara4,5, Shiroaki Shirato5
1Department of Ophthalmology, Graduate of Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. reisakata-tky@umin.ac.jp.
Abstract:
To report the frequency of hyphema after PRESERFLO® MicroShunt (PMS) surgery using double-step knife in patients with glaucoma and to investigate its relationship with the tube insertion position. Glaucoma patients who underwent PMS surgery were reviewed. Hyphema was defined as visible hemorrhage in the anterior chamber. The insertion position of PMS was confirmed via gonioscopy. Patient backgrounds in the hyphema and non-hyphema groups were compared, and the course of visual acuity (VA), intraocular pressure (IOP), and time to resolution of hyphema were investigated. 65 of 66 eyes were eligible for consideration. Hyphema had occurred in 23 (35%) eyes. At the end of surgery, anterior chamber bleeding was observed under the microscope in 8 of 23 cases (35%). The tube fixation position was on the scleral spur (25 eyes), on the trabecular meshwork (27 eyes), on the Schwalbe line (10 eyes) and on the corneal side (3 eyes). There was no significant difference of the site of tube insertion between the two groups. All cases of hyphema spontaneously resolved within a few weeks, with stable IOP and recovered VA. It is worth noting that in PMS surgery using the double-step knife, hyphema may occur high frequency even if the tube insertion site is accurately positioned. Patients should be informed of the risk of hyphema before the surgery.
Insights
Hyphema, or bleeding in the eye, occurred in 35% of patients after PRESERFLO® MicroShunt (PMS) surgery. This complication was frequent regardless of the precise tube insertion site, indicating a notable risk for patients.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Glaucoma is a leading cause of irreversible blindness worldwide.
- The PRESERFLO® MicroShunt (PMS) surgery is a surgical option for managing glaucoma.
- Understanding potential complications like hyphema is crucial for patient counseling and surgical technique refinement.
Purpose of the Study:
- To determine the frequency of hyphema following PRESERFLO® MicroShunt (PMS) surgery.
- To explore the relationship between hyphema occurrence and the specific tube insertion position.
- To analyze the impact of hyphema on visual acuity and intraocular pressure post-surgery.
Main Methods:
- Retrospective review of glaucoma patients who underwent PMS surgery using a double-step knife.
- Definition of hyphema as visible hemorrhage in the anterior chamber.
- Gonioscopic confirmation of PMS tube insertion position and comparison between hyphema and non-hyphema groups.
Main Results:
- Hyphema occurred in 23 out of 65 (35%) eligible eyes.
- No significant difference in tube insertion site was found between patients with and without hyphema.
- All hyphema cases resolved spontaneously within weeks, with stable intraocular pressure and recovered visual acuity.
Conclusions:
- Hyphema is a frequent complication of PRESERFLO® MicroShunt surgery performed with a double-step knife.
- The occurrence of hyphema appears independent of the accuracy of the tube insertion site.
- Patients should be counseled on the risk of hyphema prior to undergoing PMS surgery.
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