One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma

Abstract

Purpose To compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods In this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups. Results Patient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group. Conclusion Microshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.

Expert Consensus on the Use of the PRESERFLO™ MicroShunt Device in the Treatment of Glaucoma: A Modified Delphi Panel

“…The panellists indicated that more evidence is also needed to determine if the device can be indicated for other forms of glaucoma and/or for patients with certain comorbidities, such as high hyperopia. However, there was consensus that the device might be suitable for patients with the off-label diagnosis of pseudoexfoliation, supporting recent research that has shown the PMS has similar efficacy for patients with POAG and those with pseudoexfoliation [21]. There was consensus that it is possible to perform the procedure in patients with high myopia, but there was some disagreement among the panellists regarding this approach.…”

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma

“…In addition to the management of POAG, this device may be used to treat XFG, angle-closure glaucoma, and normal-tension glaucoma. To date there is insufficient evidence for the role of MIGS in these forms of glaucoma, which are often refractory to medical therapy, and thus represent important, growing indications for all novel surgical options [ 8 , 35 ]. Results in XFG were similar to those in patients with POAG, although higher rates of transient hypotony and choroidal detachment were observed in the former [ 35 ].…”

“…To date there is insufficient evidence for the role of MIGS in these forms of glaucoma, which are often refractory to medical therapy, and thus represent important, growing indications for all novel surgical options [ 8 , 35 ]. Results in XFG were similar to those in patients with POAG, although higher rates of transient hypotony and choroidal detachment were observed in the former [ 35 ]. The MicroShunt, like other tubes, should be used with caution in cases with narrow angles, since proximity and contact with the corneal endothelium should be avoided.…”

Risk factors and management of choroidal effusions

“…Recent studies have suggested additional associations between certain patient characteristics and the development of choroidal effusions. Pseudoexfoliative glaucoma has been linked to a higher incidence of choroidal effusions, especially when compared with primary open angle glaucoma (POAG) [14 ▪▪ ,40,41]. Shin et al [40] also identified older age, pseudophakia and hypertension as risk factors for choroidal effusion development following Ahmed glaucoma valve implantation.…”