Preserflo microshunt outcomes in pigmentary glaucoma: a propensity score-matched comparison with primary open-angle...

To evaluate the outcomes of Preserflo MicroShunt (PMS) implantation in pigmentary glaucoma (PG) and compare them with a matched primary open-angle glaucoma (POAG) cohort.

This retrospective study included consecutive patients with PG undergoing PMS implantation between 2021 and 2025 at a single tertiary centre. A 1:2 propensity score-matched POAG control group was created based on demographic and clinical baseline characteristics. The primary outcome was surgical success at 2 years, defined as ≥ 20% IOP reduction and IOP ≤ 18 mmHg without hypotony-related complications. Secondary outcomes included stricter success criteria, IOP reduction, medication use, revisions, and complications.

Thirty-one PG patients were matched to 62 POAG patients. Median follow-up was 28 and 32 months, respectively. PMS implantation resulted in significant and sustained IOP reduction in both groups (all p < 0.01), with no significant differences between PG and POAG at any time point. Median IOP at 2 years was 14 mmHg in both groups. IOP-lowering agents decreased to a median of 0 in both groups, with most patients remaining medication-free. Complete success at 2 years was 61% in PG and 49% in POAG (p = 0.35). Bleb revisions were required in 45% and 52%. Outcomes across stricter success criteria and complications were not significantly different.

PMS implantation in PG was not associated with significantly different efficacy, safety and revision burden compared with POAG. The distinct pathophysiology of PG does not appear to adversely affect surgical outcomes, supporting the PMS as a viable treatment option in this population.