Outcomes of the PreserFlo MicroShunt in Refractory Childhood Glaucoma

PreserFlo MicroShunt implantation significantly reduced intraocular pressure and medication burden in refractory childhood glaucoma. However, declining survival beyond 12 months indicates limited long-term durability.

Childhood glaucoma is a potentially blinding condition caused by elevated IOP, with particularly high prevalence in Southern Israel. Management is especially challenging in refractory cases. The Preserflo MicroShunt is a minimally invasive device designed to lower IOP by diverting aqueous humor to the subconjunctival space. This study presents our institutional experience with its use in refractory childhood glaucoma and, to our knowledge, represents the largest reported series to date.

We conducted a retrospective study of all consecutive children (≤18 y) with refractory glaucoma, defined as inadequate IOP control despite prior glaucoma surgery and maximal medical therapy, who underwent PMS implantation between October 2023 and December 2024. Data collected included pre- and postoperative IOP and the number of IOP-lowering medications. Complete success was defined as IOP <21 mm Hg and ≥25% IOP reduction without medications; qualified success allowed medications. Failure was defined as <25% IOP reduction or need for further surgery.

Thirty-four eyes from 27 patients (mean age: 4.9±3.6 y) were included. Mean follow-up was 14.85±5.02 months. The mean IOP decreased from 24.29±6.05 mm Hg to 17.95±8.22 mm Hg ( P <0.001), and mean medication numbers from 3.0±0.0-0.9±1.3 ( P <0.001). Overall success was 61.70%, with 50% achieving complete success, and the average follow-up time was 13.92±4.85 months.

The PMS lowered IOP and reduced medication use in refractory childhood glaucoma. However, the declining survival rates (53% at 12 mo and 33% at 24 mo) indicate the need for further evaluation of its long-term efficacy in children.