Systematic Preserflo MicroShunt Intraluminal Stenting for Hypotony Prevention in Highly Myopic Patients: A Comparative Study

Lupardi, Enrico; Laffi, Gian Luca; Moramarco, Antonio; Barboni, Piero; Fontana, Luigi

doi:10.3390/jcm12041677

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…(28.57 %) was comparable to other studies on the PM (11.1 to 39 % of the eyes) [15]. It suggests that the risk of postoperative hypotony with the PM in highly myopic patients and non-highly myopic patients could be the same.…”

Section: Discussionsupporting

confidence: 84%

“…During the follow-up of our patient, Lupardi et al showed an efficacity in the non-stented group and intraluminal stented group on IOP reduction (46.70 and 49.01%) with 80.95 and 76.19% complete success (IOP ≤ 18 mmHg or ≥ 30% IOP decrease without medications) at the 6-month visit. It is also interesting that the rate of hypotony in the non-stented group (28.57%) was comparable to other studies on the PM (11.1 to 39% of the eyes) 15 . It suggests that the risk of postoperative hypotony with the PM in highly myopic patients and non-highly myopic patients could be the same.…”

Section: Discussionsupporting

confidence: 84%

“…A rare phenomenon of wipe-out can also be associated with postoperative hypotony, resulting in an irreversible sudden visual loss [14]. Currently, few studies have been published on the classic filtering surgeries (TRAB or deep non-perforating sclerectomy) for POAG in highly myopic patients, and only one recent study by Lupardi et al on the use of minimally invasive bleb surgery (MIBS), the PRESERFLO™ MicroShunt (PM), in highly myopic patients was published [15]. The PM (Santen Inc., Osaka, Japan), known also as the InnFocus MicroShunt, has been manufactured to treat POAG but not especially in patients with high myopia.…”

Section: Zusammenfassungmentioning

confidence: 99%

“…The comparative study of Lupardi et al on PM intraluminal stenting for hypotony prevention showed the efficacity and safety of the PM in high myopia at 6 months as secondary outcomes. The primary outcome was the absence of postoperative hypotony in intraluminal stenting PM (0 %) vs. non-intraluminal stenting PM (28.6 %), suggesting that the intraluminal stenting technique was better than a lower mitomycin C (MMC) concentration to avoid postoperative hypotony and associated complications such as hypotony maculopathy, choroidal detachment, suprachoroidal hemorrhage, or even tube-cornea touch [15].…”

Section: Preserflo™ Microshuntmentioning

confidence: 99%

“…PM implantation was performed with a standard described surgery in both eyes at 2-month intervals. The intraluminal stenting for the prevention of postoperative hypotony proposed by Lupardi et al could have been an opportunity to reduce the risk of postoperative hypotony, but unfortunately, this publication had not yet been available at the time the procedure was carried out [15]. Surgery in the LE was performed under peribulbar anesthesia with pupillary constriction under Spersacarpine 2 % 3× preoperatively.…”

Section: Surgery and Postoperative Follow-up Of The Casementioning

confidence: 99%

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PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature

George,

Abouzeid

2024

Klin Monbl Augenheilkd

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The PRESERFLO™ MicroShunt (MP; Santen Inc., Osaka, Japan) is a minimally invasive bleb surgery (MIBS) manufactured to treat primary open-angle glaucoma (POAG), with lower postoperative adverse effects than with conventional filtering surgeries. We describe here the case study of a 58-year-old woman who presented with bilateral severe myopia with bilateral advanced POAG and unreached target pressure under quadritherapy, who was successfully managed by PM surgery. A review of the literature completes our observation. At presentation, the patient had a spherical equivalent of − 7.50 RE and − 7.75 LE with an IOP of 22 mmHg right and left eye (RLE) under quadritherapy, and with severe bilateral visual field loss, including scotomas within the central 5°. The patient presented with systemic hypertension treated with an antihypertensive drug. Two selective laser trabeculoplasties (SLT), performed 3 months apart, were first tried on the LE, without any change in IOP at 2 months. After considering the high risk of postoperative complications, a PM operation was proposed, with a targeted IOP in the mid-fifteens RLE. The patientʼs eyes underwent PM surgery with mitomycin C (MMC) MMC0.2 mg/mL for 3 minutes without any complications. The LE required 2 consecutive needlings with 1 mL MMC0.2 mg/mL. At 24 months after surgery, the two eyes gave successful results without the need for any additional medical therapy, and with well-functioning conjunctival blebs. The PM was an effective alternative to the gold standard trabeculectomy in our severely myopic patient. A comparative study between conventional filtering operations and this MIBS in highly myopic patients would confirm our observation.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

Section: Zusammenfassungmentioning

confidence: 99%

Section: Preserflo™ Microshuntmentioning

confidence: 99%

Section: Surgery and Postoperative Follow-up Of The Casementioning

confidence: 99%

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PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature

George,

Abouzeid

2024

Klin Monbl Augenheilkd

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The use of intraluminal PRESERFLO stenting in avoiding early postoperative hypotony

Verma-Fuehring,

Dakroub,

Bamousa

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose Postoperative hypotony following PRESERFLO MicroShunt (PMS) implantation is a frequent cause of complications such as choroidal detachment and hypotony maculopathy. This study aims at evaluating the impact of intraluminal stenting of the PMS during the early postoperative period. Methods We retrospectively analyzed the data of 97 patients who underwent PMS implantation with intraoperative placement of a Nylon 10–0 suture as intraluminal stent (PStent) and compared the outcomes to those of an existing database of the traditional MicroShunt implantation technique (PTrad, n = 120). The primary outcome measure was the intraocular pressure (IOP) at one week postoperatively. As a secondary outcome measure, adverse hypotony, defined as an IOP ≤ 5 mmHg with significant choroidal effusion and/or anterior chamber shallowing or the presence of macular folds was also assessed. Additionally, the time to stent removal and the IOP one week after stent removal were reported. Results Preoperative median IOP was 25.0 (20.5–30.3) mmHg in PStent and 25.0 (19.3–32.0) mmHg in PTrad (p = 0.62). One week after surgery, the median IOP dropped to 10.0 (8.0–13.0) mmHg in PStent and 7.0 (5.0–9.0) in PTrad (p < 0.01). At one month, the IOP was 12.0 (10.0–14.0) mmHg in PStent and 10.0 (8.0–11.0) mmHg in PTrad (p < 0.01). After 3 months, both groups showed similar median IOP levels of 11.0 (8.0–13.5) mmHg and 10.0 (9.75–13.0) mmHg in PStent and PTrad, respectively (p = 0.66). The presence of adverse hypotony was significantly lower in PStent compared to PTrad (6.2% vs 15.8%, p < 0.05). In PStent the stent was removed after 30.0 (21.0–42.5) days. One week after stent removal the mean IOP drop was 6.1 ± 0.5 mmHg (p < 0.01). Conclusion In the early follow-up period, intraluminal stenting of the PMS appears to be safe and effective in controlling the IOP while reducing early postoperative hypotony. Surgical success is not compromised by stent placement. Based on our data, it is recommended to remove the suture two to six weeks after surgery for most patients with uncomplicated postoperative clinical findings.

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Additional Guidance on the Use of the PRESERFLO™ MicroShunt in the Treatment of Glaucoma: Insights from a Second Delphi Consensus Panel

Khawaja,

Abegão Pinto,

Stalmans

et al. 2024

Ophthalmol Ther

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Introduction The PRESERFLO™ MicroShunt (PMS) has been proven to significantly lower intraocular pressure (IOP) in patients with glaucoma and has been available for use since 2019. With increasing published evidence and growing experience of glaucoma surgeons, the aim of this modified Delphi panel was to build on the findings of a previous Delphi panel conducted in 2021 and provide further guidance on the role of the PMS to treat patients with glaucoma in Europe. Methods Thirteen European glaucoma surgeons experienced in the PMS procedure participated in a 3-round modified Delphi panel. A targeted literature review and expert steering committee guided Round 1 questionnaire development. Consensus was pre-defined at a threshold of ≥ 70% of panellists selecting ‘strongly agree’/‘agree’ or ‘strongly disagree’/‘disagree’ for 6-point Likert scale questions or ≥ 70% selecting the same option for multiple or single-choice questions. Questions not reaching consensus were restated/revised for the next round, following guidance from freetext responses/scoping questions. Results In total, 28% ( n = 9/32), 52% ( n = 16/31) and 91% ( n = 10/11) of statements reached consensus in Rounds 1, 2 and 3, respectively. There was agreement that the PMS may be used in patients with pigmentary, post-trauma or post-vitrectomy glaucoma and for patients with uveitic glaucoma without active inflammation. The PMS may be more suitable for patients with contact lenses than other subconjunctival filtering surgeries, without eliminating bleb-associated risks. Consensus was reached that combining PMS implantation and phacoemulsification may be as safe as standalone PMS surgery, but further efficacy data are required. Following a late rise in IOP ≥ 4 months post-surgery, topical aqueous suppressant drops or bleb revision may be suitable management options. Conclusions This Delphi panel builds on the considerations explored in the 2021 Delphi panel and provides further detailed guidance for glaucoma surgeons on the use of the PMS, reflecting the availability of novel evidence and surgical experience. Videos are available for this article. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-024-00902-5.

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Systematic Preserflo MicroShunt Intraluminal Stenting for Hypotony Prevention in Highly Myopic Patients: A Comparative Study

Cited by 8 publications

References 32 publications

PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature

PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature

The use of intraluminal PRESERFLO stenting in avoiding early postoperative hypotony

Additional Guidance on the Use of the PRESERFLO™ MicroShunt in the Treatment of Glaucoma: Insights from a Second Delphi Consensus Panel

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