Comparing the safety and efficacy of Preserflo Microshunt implantation and trabeculectomy for glaucoma: A systematic review and meta‐analysis

Abstract

To compare the safety and efficacy of the Preserflo Microshunt with trabeculectomy in the treatment of patients with glaucoma. A systematic review and meta‐analysis was conducted. The primary outcome measures recorded as a measure of efficacy of the interventions were intra‐ocular pressure (IOP) at final follow‐up and IOP reduction (IOPR). Secondary outcomes recorded to measure efficacy were reduction in the number of glaucoma medications and reinterventions. To assess safety profile, the proportions of patients with post‐operative complications were recorded. Seven articles were included in this study. A total of 1353 eyes were included in this review (Preserflo: 812, trabeculectomy: 541). Post‐operative IOP (mean difference [MD] = 0.78 [0.66, 0.90], p < 0.001) results are significantly lower for trabeculectomy than Preserflo. The IOPR (MD = −1.20 [−2.30, −0.09], p = 0.034) results significantly favour trabeculectomy over Preserflo Microshunt. The reduction in topical glaucoma medications (MD = −0.32 [−0.58, −0.07], p = 0.014) is significantly higher for trabeculectomy. There is no statistically significant difference in levels of hypotony (risk ratio [RR] = −0.05 [−0.47, 0.37], p = 0.806), choroidal effusion/detachment (RR = −0.12 [−0.42, 0.19], p = 0.444), hyphaema (RR = 0.20 [−0.11, 0.51], p = 0.216) and flat anterior chamber (RR = 0.49 [−1.02, 0.03], p = 0.066). There are significantly more bleb‐related complications in the trabeculectomy groups than Preserflo groups (RR = −0.63 [−1.01, −0.24], p = 0.001). There were statistically more reinterventions required in the trabeculectomy groups than Preserflo groups (RR = −0.48 [−0.65, −0.30], p < 0.001). Compared to trabeculectomy, the Preserflo Microshunt is not as effective in lowering intra‐ocular pressure, has a similar safety profile and has a lower reintervention rate. Further research is required given the lack of randomised controlled trials within this study and resulting low strength of evidence.