Changes to Corneal Topography and Biometrics After PRESERFLO Microshunt Surgery for Glaucoma

Barberá, Marta Ibarz; Morales-Fernández, Laura; Liaño, Rosario Gómez de; Rivero, Pedro Taña; Teus, Miguel A.

doi:10.1097/ijg.0000000000001912

Cited by 12 publications

(19 citation statements)

References 30 publications

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“…There is no clear consensus in the peer-reviewed literature on the most efficacious dose and time of MMC to be used during this surgery 22. In our study, 0.2 mg/mL MMC was used for 2 minutes as it has been done in previous studies,10–13,16,20 because the scientific evidence to strongly recommend the use of higher concentrations of MMC in populations of European descent is still scarce. Previously reported data from a multicenter study conducted across multiple European sites by multiple surgeons using 2 different concentrations of MMC (0.2 and 0.4 mg/mL)14 showed that postoperative IOP was similar between both subgroups at 1 and 2 years, however, there was a trend toward a greater IOP reduction with 0.4 mg/mL MMC compared with 0.2 mg/mL MMC after month 6 (the differences were significant only at 6 mo, probably because the study was not powered to assess the effects of different MMC concentrations).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma

Barberá¹,

Galdón²,

Magro³

et al. 2022

Journal of Glaucoma

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Précis: The Preserflo Microshunt (PSM) is a safe and effective glaucoma microfiltering implant that significantly reduces the intraocular pressure (IOP), either alone or in combination with phacoemulsification, during the first year after surgery. Purpose:The purpose of this study was to assess the safety and efficacy of the PSM for the treatment of open angle glaucoma with 0.2 mg/mL mitomycin C, either alone or in combination with cataract surgery. Methods:A retrospective, open-label study of 64 eyes with primary open angle glaucoma that underwent PSM implantation and were followed up for at least 9 months. Success was defined as IOP 6-17 mm Hg and a reduction of at least 20%, complete without hypotensive medication, and qualified with medication. Safety was assessed by the incidence of adverse events. Secondary endpoints included mean hypotensive medications, visual acuity, and incidence of needling and surgical revision.Results: A total of 51 eyes underwent PSM alone and 13 underwent PSM+phacoemulsification. In the overall population of the study, the mean IOP was significantly reduced from 22.03 ± 0.7 mm Hg at baseline to 12.7 ± 0.4 mm Hg at the final visit, P < 0.0001 (mean follow-up: 11 ± 1.4 mo). The IOP was significantly reduced in both groups (P < 0.0001). Ocular hypotensive medication was reduced significantly from 2.7 ± 0.7 to 0.2 ± 0.5 (P < 0.0001). No significant differences were found in IOP-lowering medication between groups (PSM alone, 0.2 ± 0.08; PSM+phacoemulsification, 0.1 ± 0.1; P = 0.2). At the final visit, 70.3% were considered as complete success and 12.5% as qualified success. The most common adverse event was clinical hypotony (7.8%) followed by hyphema (4.7%), and anterior chamber reformation (1.6%). Overall, 1.6% required needling and 15.6% surgical revision to restore the flow. Conclusion:Glaucoma surgery with the PSM and mitomycin C was efficacious and safe in the short term, either alone or in combination with cataract surgery, and may be considered a surgical option for lowering IOP in primary open angle glaucoma.

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Section: Discussionmentioning

confidence: 99%

“…The surgical procedure for PSM implantation has been previously described by our group. 13 In brief: "All surgeries were performed by the same surgeon (M.I.B. ), with sub-Tenon anesthesia in the inferior-nasal quadrant.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma

Barberá¹,

Galdón²,

Magro³

et al. 2022

Journal of Glaucoma

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“…The surgical technique has been previously reported by our group [ 8 ]: https://journals.lww.com/glaucomajournal/Fulltext/2021/10000/Changes_to_Corneal_Topography_and_Biometrics_After.8.aspx .…”

Section: Methodsmentioning

confidence: 99%

“…A side-port incision was created at the end of the surgery to inject 0.1 ml of cefuroxime (1 mg/0.1 ml) into the AC. For combined surgery, the surgical technique was the same and performed at the end of the phacoemulsification and IOL [intraocular lens] implantation procedure” [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Corneal Endothelial Cell Loss After PRESERFLO™ MicroShunt Implantation in the Anterior Chamber: Anterior Segment OCT Tube Location as a Risk Factor

et al. 2021

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Introduction:To analyze the effects of PRE-SERFLO on corneal endothelial cell density (ECD). Methods: Forty-six eyes that underwent PRE-SERFLO implantation were followed up for 12 months. Specular microscopy was performed preoperatively and at 1, 3, 6, and 12 months postoperatively to measure central ECD and mean monthly reduction (MMR). Anterior segment optical coherence tomography (AS-OCT) was applied to measure the tube-endothelium (TE \ 200 lm, 201-500 lm, [ 500 lm) distance. The relationship between TE distance and ECD was analyzed with a linear mixed-effects model. Results: Central ECD decreased significantly at 1 year (7.4%, p = 0.04), with an MMR of -15 ± 25 cells/mm 2 . Regarding TE distance groups, there was an 18% ECD reduction in the \ 200 lm group vs. 1% in the [ 500 lm group (p = 0.08). Endothelial cell loss was related to TE distance (mean 482.9 ± 238 lm), with a higher rate at 1 month in comparison to 12 months for the same tube position in the anterior chamber (-174.8 ± 65.2 cells/mm 2 at 1 month vs. 30.2 ± 11.3 cells/mm 2 at 12 months, p \ 0.01). From month 6, tubes located [ 600 lm from the endothelium showed EC loss close to zero. Conclusions: The PRESERFLO implant is associated with a loss of EC from the immediate postoperative period that continues over time at lower rates. A shorter TE distance appears to cause more severe ECD loss.

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“…We believe a combination of VEGF suppression and shunt-based procedure would be beneficial to those requiring surgical intervention, with cyclodiode therapy used as an alternative adjunct—showing good IOP reduction (not without its own risks and sight threatening complications). More recent literature on the utilisation of surgical micro-shunts in the treatment of secondary glaucoma has shown promising results [ 35 ]. Further work must be done to look at the potential role of interventional glaucoma and long-term outcomes in patients with neovascular glaucoma.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice

Ramji

Nagi

Ansari

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose Neovascular glaucoma (NVG) is characterised by neovascularisation of the angle and therefore elevated intraocular pressure (IOP). This results in progressive optic neuropathy and loss of visual acuity. Treatment aims to reduce IOP in order to prevent optic nerve damage. A systematic review was completed synthesising results from randomised control trials (RCTs) comparing interventions for the management of NVG and their efficacy and safety. Methods Data was sourced from Web of Science, Embase and Medline after 1st January 2000. The primary outcome measures were mean IOP at follow-up and success rate. The secondary outcomes included mean IOP lowering medications and total complications. A meta-analysis was completed on comparative studies using Revman (version 5.4). Results For the two studies comparing Ahmed glaucoma valve (AGV) + pan-retinal photocoagulation (PRP) vs AGV + PRP + intra-vitreal bevacizumab (IVB), there was no difference in mean IOP or odds of success from the meta-analysis. From the 4 studies examining the utilisation of anti-vascular endothelial growth factor (anti-VEGF), one study showed lower mean IOP at 1 (p = 0.002) and 3 months (p = 0.033) for IVB vs sham injection. In the 2 studies studying transcleral diode laser (TDL), there were no significant findings. From the 4 studies looking at trabeculectomy (trab), lower mean IOP at 6 (p = 0.001), 9 (p = 0.01), 12 (p = 0.02) and 18 months (p = 0.004) was shown for intra-vitreal ranibizumab (IVR) + PRP + visco-trabeculectomy vs IVR + PRP + trab, and a significantly lower mean IOP was present in the Baerveldt group vs trab at 6 months (p = 0.03). In the 2 studies investigating the AGV, there was a lower mean IOP at 1 month (p = 0.01) in the AGV + triamcinolone (TCA) group. The risk of bias was low for 4 studies, high for 4 studies and 6 studies had some concerns. Conclusion This is the first meta-analysis of RCTs in the management of neovascular glaucoma. The lack of high-quality evidence contributes to the lack of consensus in managing NVG. Our results highlight modern treatment strategies and the need for better powered RCTs with long-term follow-up in order to establish optimal treatment modalities and true patient outcomes.

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Changes to Corneal Topography and Biometrics After PRESERFLO Microshunt Surgery for Glaucoma

Cited by 12 publications

References 30 publications

Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma

Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma

Corneal Endothelial Cell Loss After PRESERFLO™ MicroShunt Implantation in the Anterior Chamber: Anterior Segment OCT Tube Location as a Risk Factor

A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice

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