Related Experiment Video
Updated: Sep 10, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Exposure of PreserFlo Microshunt: Risk Factors and Surgical Management
Laura Morales-Fernández1,2, Javier García-Bardera1, José M Martínez-de-la-Casa3,4
1Ophthalmology Unit, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain.
Abstract:
Preserflo MicroShunt (PMS) has emerged as a safe and effective subconjunctival implant for lowering intraocular pressure in glaucoma. Although most postoperative complications occur early and are transient, long-term data remain limited-particularly regarding rare but serious events such as device exposure or extrusion, which may threaten ocular integrity. This report presents 3 clinical cases of PMS exposure with distinct presentations, potential risk factors, and surgical management approaches. In the first case, a pseudophakic patient with primary open angle glaucoma developed exposure of the device body 8 months postoperatively, associated with conjunctival ischemia but without leakage. In the second case, exposure of a nonfunctioning PMS occurred 2 years after a second implant was placed in a different quadrant, following early failure of the original device. The exposed implant was removed without compromising IOP control. The third and most severe case involved extensive scleral melting, distal extrusion, and Seidel positivity, requiring device explantation and scleral grafting. Contributing factors included the use of 0.04% mitomycin C, previous surgeries, and intraoperative identification of thin Tenon's capsule. Based on these cases, PMS exposure may arise through different mechanisms-distal extrusion, body erosion, or conjunctival dehiscence-each necessitating tailored surgical intervention. Awareness of risk factors and prompt management are essential to prevent complications such as infection or hypotony. These findings highlight the importance of careful intraoperative assessment, personalized MMC application, and early detection to ensure long-term safety and device preservation.
Insights
Preserflo MicroShunt (PMS) device exposure is a rare but serious complication in glaucoma surgery. Prompt recognition and tailored surgical management are crucial for preserving ocular integrity and preventing vision loss.
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.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:22Aneurysm IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management