Early Clinical Outcomes of the Preserflo Microshunt Device
DOI:
https://doi.org/10.48560/rspo.25962Keywords:
Glaucoma/surgery, Glaucoma Drainage Implants, Filtering Surgery, Intraocular PressureAbstract
INTRODUCTION: The purpose of this study was to assess the efficacy and safety profile of the Preserflo® Microshunt device, which is an ab externo sub-Tenon’s aqueous shunt approved for the surgical treatment of glaucoma,
METHODS: Retrospective single-center observational study. Patients who underwent stan- dalone or combined phacoemulsification-Preserflo® Microshunt implantation with a minimum of 3 months of post-operative follow-up were included. Primary outcome measures included surgi- cal success defined as a ≥ 30% decrease in IOP from baseline and unmedicated IOP ≤18 mmHg. Secondary outcomes included number of hypotensive drops and adverse effects.
RESULTS: Ninety-two (92) eyes from 77 patients (mean±SD age 68±18 years) were included, most of which underwent standalone surgery (n=74 eyes; 80%). Average post-operative follow-up time was 9±6 months, with over three quarters of eyes (n=70; 76%) completing at least 6 months of follow-up and a third (n=30; 33%) with at least 12 months. Mean IOP was significantly reduced from a baseline measurement of 22±5.8 mmHg throughout follow-up, with a 12-month IOP of 13.9±4.8 mmHg (p<0.0001). Mean number of medications was reduced from 2.8±0.9 to 0.5±0.9 at last follow-up (p<0.0001), with 75% of eyes remaining drop-free throughout follow-up. Absolute success at 12 months was 46% and 64% if medication was allowed (qualified). Complications included self-limited intra-operative bleeding or post-operative hyphema (total n=9; 10%), and shallow anterior chamber (n=4; 4%). No major or sight-threatening complication was recorded.
CONCLUSION: Early audit of real-world data from Preserflo® use suggests this to be a safe and effective surgical option for the treatment of medically uncontrolled glaucoma.
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References
Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-anal- ysis. Ophthalmology. 2014;121:2081-90. doi:10.1016/j.oph- tha.2014.05.013
Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Heal. 2021;9:e144-e160. doi:10.1016/S2214-109X(20)30489-7
Vinod K, Gedde SJ, Feuer WJ, Panarelli JF, Chang TC, Chen PP, et al. Practice Preferences for Glaucoma Surgery. J Glaucoma. 2017;26:687-693. doi:10.1097/IJG.0000000000000720
Rathi S, Andrews CA, Greenfield DS, Stein JD. Trends in Glaucoma Surgeries Performed by Glaucoma Subspecialists versus Nonsubspecialists on Medicare Beneficiaries from 2008 through 2016. Ophthalmology. 2021;128:30-8. doi:10.1016/j. ophtha.2020.06.051
Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment Outcomes in the Tube Versus Trabeculectomy (TVT) Study After Five Years of Follow-up. Am J Ophthalmol. 2012;153:789-803.e2. doi:10.1016/j.ajo.2011.10.026
Gedde SJ, Feuer WJ, Lim KS, Barton K, Goyal S, Ahmed IK, et al. Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 3 Years of Follow-up. Ophthalmology. 2020;127:333-45. doi: 10.1016/j.ophtha.2019.10.002.
Chu C, Liebmann JM, Ciof GA, Blumberg DM, Al-aswad LA. Reoperations for Complications Within 90 Days After Glaucoma Surgery. J Glaucoma. 2020;29:344-6. doi:10.1097/ IJG.0000000000001484
Conlon R, Saheb H, Ahmed IIK. Glaucoma treatment trends: a review. Can J Ophthalmol. 2017;52:114-24. doi:10.1016/j. jcjo.2016.07.013
Coleman AL, Richter G. Minimally invasive glaucoma sur- gery: current status and future prospects. Clin Ophthalmol. 2016:189. doi:10.2147/OPTH.S80490
European Glaucoma Society. Terminology and Guidelines for Glaucoma. 5th ed. Amsterdam: Publicomm; 2020.
Pinchuk L, Riss I, Batlle JF, Kato YP, Martin JB, Arrieta E, et al. The use of poly(styrene-block-isobutyleneblock- styrene) as a microshunt to treat glaucoma. Regen Biomater. 2016;3:137-42. doi:10.1093/RB/RBW005
Batlle JF, Fantes F, Riss I, Pinchuk L, Alburquerque R, Kato YP, et al. Three-year follow-up of a novel aqueous humor microshunt. J Glaucoma. 2016;25:e58-e65. doi:10.1097/ IJG.0000000000000368
Shaarawy TM, Aptel F, Beckers HJ. 12-month interim results of a multicentre open-label study of the InnFocus MicroShunt® Glaucoma Drainage System in patients with primary open- angle glaucoma. Invest Ophthalmol Vis Sci. 2018;59:3457.
Fea AM, Laffi GL, Martini E, Economou MA, Caselgrandi P, Sacchi M, et al. Effectiveness of MicroShunt in Patients with Primary Open-Angle and Pseudoexfoliative Glaucoma: A Retrospective European Multicenter Study. Ophthalmol Glaucoma. 2022;5:210-8. doi: 10.1016/j.ogla.2021.08.005.
Schlenker MB, Durr GM, Michaelov E, Ahmed IK. Intermedi- ate Outcomes of a Novel Standalone Ab Externo SIBS Microshunt With Mitomycin C. Am J Ophthalmol. 2020;215:141-53. doi:10.1016/j.ajo.2020.02.020
Beckers HJ, Aptel F, Webers CA, Bluwol E, Martínez-de-la- Casa JM, García-Feijoó J, et al. Safety and Effectiveness of the PRESERFLO® MicroShunt in Primary Open-Angle Glaucoma: Results from a 2-Year Multicenter Study. Ophthalmol Glaucoma. 2022;5:195-209. doi: 10.1016/j.ogla.2021.07.008.
Martínez-de-la-Casa JM, Saenz-Francés F, Morales-Fernandez L, et al. Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients. Sci Rep. 2021;11:1-8. doi:10.1038/s41598-021-95217-x
Baker ND, Barnebey HS, Moster MR, Stiles MC, Vold SD, Khatana AK, et al. Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: One-Year Results from a 2-Year Randomized, Multicenter Study. Ophthalmol- ogy. 2021;128:1710-21. doi: 10.1016/j.ophtha.2021.05.023.
Shaarawy TM, Sherwood MB, Grehn F, editors. Guidelines on Design and Reporting of Surgical Trials - World Glaucoma Association. Philadelphia: Kugler Publications; 209.
Pillunat KR, Herber R, Haase MA, Jamke M, Jasper CS, Pil- lunat LE. PRESERFLOTM MicroShunt versus trabeculecomy: first results on efficacy and safety. Acta Ophthalmol. 2022;100:e779-e790. doi: 10.1111/aos.14968.
Gizzi C, Costa G, Servadei R, Abed E, Ning B, Sharma A, et al. A case of malignant glaucoma following insertion of PreserfloTM MicroShunt. Eur J Ophthalmol. 2022;32:NP115-9. doi: 10.1177/11206721211003492.
Micheletti E, Riva I, Bruttini C, Quaranta L. A Case of Delayed- onset Hemorrhagic Choroidal Detachment after PreserFlo Microshunt Implantation in a Glaucoma Patient under Anti- coagulant Therapy. J Glaucoma. 2020;29:E87-E90. doi:10.1097/ IJG.0000000000001584
Agrawal P, Bradshaw SE. Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery ( MIGS ) in Primary Open-Angle Glaucoma. Ophthalmol Ther. 2018;7:49-73. doi:10.1007/s40123-018-0131-0 Derick RJ, Evans J, Baker ND. Combined phacoemulsification and trabeculectomy versus trabeculectomy alone: a com- parison study using mitomycin-C. Ophthalmic Surg Lasers. 1998;29:707-13.
Marcos Parra MT, Salinas López JA, López Grau NS, Ceaus- escu AM, Pérez Santonja JJ. XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsi- fication, in open-angle glaucoma patients. Graefe’s Arch Clin Exp Ophthalmol. 2019;257:1741-50. doi: 10.1007/s00417-019- 04341-y.
Siriwardena D, Kotecha A, Minassian D, Dart JK, Khaw PT. Anterior chamber flare after trabeculectomy and after phacoemulsification. Br J Ophthalmol. 2000;84:1056-7. doi:10.1136/ bjo.84.9.1056
Kerr NM, Ahmed IIK, Pinchuk L, Sadruddin O, Palmberg PF. PRESERFLO MicroShunt. In: Minimally Invasive Glaucoma Surgery. Berlin: Springer; 2021. p.91-103.
Kirwan JF, Lockwood AJ, Shah P, et al. Trabeculectomy in the 21st century: A multicenter analysis. Ophthalmology. 2013;120:2532-9. doi:10.1016/j.ophtha.2013.07.049
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