PreserFlo MicroShunt® exposure: a case series

Abstract

Background PreserFlo® MicroShunt (PM) (also known as InnFocus® MicroShunt) is a subconjunctival stent implanted ab externo via a minimally invasive surgical procedure. The current indication is progressive, mild to moderate, open angle glaucoma uncontrolled on topical medications. According to the literature, adverse events are rare, mild and transient. Case presentation Two cases of stand-alone PreserFlo MicroShunt® implantation in patients with uncontrolled open-angle glaucoma are reported. Exposure occurred 7 days and 3 months respectively after implantation. These cases shared common features including preexisting blepharitis and the lack of a Tenon’s flap. In both cases, removal of the device was required after several attempts at repair. Conclusions PreserFlo MicroShunt® exposure is a potentially vision-threatening complication because of the risk of endophthalmitis. Potential risk factors include the absence of a Tenon’s flap and pre-existing ocular surface inflammation. Ocular surface inflammation should be detected and treated prior to PM implantation. If a deficiency in Tenon’s capsule is noted intraoperatively, close monitoring should be performed because of the higher risk of PM exposure.

Early Complications and Results of Preserflo MicroShunt in the Management of Uncontrolled Open-Angle Glaucoma: A Case Series

“…Thus, the Preserflo MicroShunt, a minimally invasive glaucoma surgery device, has a good efficacy and safety profile as compared to other MIGS [ 23 , 24 , 25 , 26 ]. In contrast to the study of Bunod et al [ 27 ], we did not observe any cases of tube exposure in our research.…”

Conjunctival erosion following a PRESERFLO® MicroShunt procedure

“…The approach has been recommended by another group in the context of deficient tenon's capsule (discussed in more detail below). 7 It is not clear at this point whether the inclusion of a nylon suture provides additional benefit. However, we have not had other similar suture related issues and we continue to incorporate its use with MicroShunt procedures.…”

“…Finally, a recent series of 2 cases of MicroShunt exposure cited severe blepharitis associated with ocular surface inflammation and deficiency in tenons capsule as common features between them. 7 One of the patients had undergone a non-penetrating deep sclerectomy in both eyes 5 years prior. In situations where there is a deficiency of tenon's capsule, the authors recommend use of a 10-0 nylon suture to fix the distal part of the MicroShunt to the sclera, in a similar manner to which we have described.…”

PreserFlo® MicroShunt: An Overview of This Minimally Invasive Device for Open-Angle Glaucoma

“…The safety profile of the PreserFlo MicroShunt was confirmed to be excellent in recent years, with only a few cases of sight-threatening adverse effects described in the literature. Bunod et al described two cases of PreserFlo exposure, which required device removal, in eyes with pre-existing blepharitis and the lack of a Tenon’s flap [ 59 ]. This potentially vision-threatening complication, because of the risk of endophthalmitis, suggested that ocular surface inflammation should be detected and treated prior to device implantation [ 59 ].…”

“…Bunod et al described two cases of PreserFlo exposure, which required device removal, in eyes with pre-existing blepharitis and the lack of a Tenon’s flap [ 59 ]. This potentially vision-threatening complication, because of the risk of endophthalmitis, suggested that ocular surface inflammation should be detected and treated prior to device implantation [ 59 ]. The risk of endophthalmitis after PreserFlo implant surgery remains unclear, with only Brambati et al reporting a case of ocular infection following post-operative needling procedures, managed with therapeutic pars plana vitrectomy (PPV) and antibiotics injection [ 54 ].…”