Exposure of PreserFlo Microshunt: Risk Factors and Surgical Management.

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Medical Device Complications

Background:

• The Preserflo MicroShunt (PMS) is an effective subconjunctival implant for reducing intraocular pressure (IOP) in glaucoma patients.
• While generally safe, long-term data on rare but severe complications like device exposure or extrusion are limited.

Purpose of the Study:

• To report three distinct clinical cases of Preserflo MicroShunt exposure.
• To analyze the varied presentations, potential risk factors, and surgical management strategies for PMS exposure.
• To emphasize the importance of early detection and intervention for preventing serious ocular complications.

Main Methods:

• Retrospective case series analysis of three patients experiencing Preserflo MicroShunt exposure.
• Detailed review of clinical presentations, surgical histories, intraoperative findings, and postoperative management.
• Identification of potential contributing factors, including mitomycin C use, prior surgeries, and conjunctival integrity.

Main Results:

• Case 1: Device body exposure with conjunctival ischemia 8 months post-op in a pseudophakic patient.
• Case 2: Exposure of a non-functioning PMS 2 years after a second implant, successfully removed without affecting IOP control.
• Case 3: Severe scleral melting and distal extrusion requiring explantation and scleral grafting, linked to mitomycin C, prior surgeries, and thin Tenon's capsule.

Conclusions:

• Preserflo MicroShunt exposure can manifest through distal extrusion, body erosion, or conjunctival dehiscence, requiring individualized surgical approaches.
• Risk factors such as mitomycin C application, previous surgeries, and intraoperative assessment of conjunctival/Tenon's capsule thickness are critical.
• Vigilance for risk factors, meticulous surgical technique, and prompt management are essential for long-term PMS safety and efficacy.