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Standalone versus combined preserflo MicroShunt surgery: A two-year controlled cohort study
Javier García-Bardera1,2, Julián Garcia-Feijoo3,4, Mireia García-Bermúdez5
1Ophthalmology Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain. Javier.bardera97@gmail.com.
Standalone Preserflo MicroShunt (PMS) surgery offers better intraocular pressure control and surgical success than combined procedures for open-angle glaucoma. This indicates PMS may be more effective for advanced glaucoma cases needing maximum pressure reduction.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Medical Devices
Background:
- Open-angle glaucoma (OAG) management aims to reduce intraocular pressure (IOP) to prevent optic nerve damage.
- The Preserflo MicroShunt (PMS) is a device used to lower IOP.
- Combining PMS implantation with phacoemulsification is an alternative surgical approach.
Purpose of the Study:
- To compare the efficacy, safety, and surgical success of standalone Preserflo MicroShunt (PMS) implantation versus PMS combined with phacoemulsification in open-angle glaucoma (OAG) patients.
- To evaluate intraocular pressure (IOP) reduction and the need for glaucoma medications at two years post-surgery.
- To assess surgical success rates based on predefined IOP reduction criteria.
Main Methods:
- A retrospective cohort study analyzed 173 eyes of OAG patients who underwent either standalone or combined PMS surgery.
- All surgeries utilized 0.04% mitomycin C.
- Primary outcomes included IOP, medication use, and surgical success (defined by ≥20% or ≥30% IOP reduction with IOP <18 mmHg) at 2 years.
Main Results:
- Mean IOP decreased significantly in both groups, with a greater reduction in the standalone PMS group (-39.4%) compared to the combined group (-33.0%) (p=0.023).
- Standalone PMS showed higher success rates: 76.1% vs. 61.7% for criterion 1 and 70.0% vs. 41.7% for criterion 2.
- Kaplan-Meier analysis revealed superior cumulative success for standalone PMS (HR 1.77, p=0.044 for criterion 1; HR 2.40, p=0.0003 for criterion 2).
- Complication rates were similar (36.3% standalone vs. 41.7% combined), with few requiring intervention (6.4%).
Conclusions:
- Both standalone and combined PMS implantation effectively reduce IOP and medication needs with acceptable safety profiles.
- Standalone PMS implantation demonstrates superior mid-term IOP control and higher surgical success rates.
- Standalone PMS is a favorable option for advanced glaucoma cases requiring maximal IOP reduction.
