Trans-conjunctival Erosion of a Novel SIBS Microshunt After Revision Surgery Using Mitomycin C

Michaels, Luke; Holland, Lee; Mercieca, Karl

doi:10.1097/ijg.0000000000001848

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Interestingly, the rate of severe postoperative hypotony after implantation of a Preserflo ® MicroShunt appears to be lower than in other surgeries for refractory glaucoma [ 21 ]. However, several cases of spontaneous extrusion of the Preserflo ® MicroShunt have been reported in the literature [ 10 , 22 , 23 ]. This should lead to caution in the choice of the duration and concentration of MMC applied during surgery.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Majoulet

Scemla

Hamard

et al. 2022

JCM

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Purpose: To evaluate the safety and efficacy of Preserflo® microshunt implantation in eyes with refractory glaucoma. Methods: In this retrospective study, a cohort of patients who underwent Preserflo® microshunt implantation between April 2019 and August 2020 for refractory glaucoma were evaluated. At the time of surgery, all eyes had uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy and at least one previous failed glaucoma filtering surgery. The primary outcome was a complete success, defined as postoperative IOP ≤ 21 mm Hg with an IOP reduction ≥ 20% and no repeat filtering surgery. The secondary outcome was qualified success, defined as a complete success with the use of antiglaucoma medications. The rates of needling, bleb repair, and postoperative complications were also recorded. Results: Forty-seven eyes with a mean preoperative IOP of 30.1 ± 7.1 mm Hg and a mean of 3.4 ± 1 glaucoma medications were included. The mean number of previous surgeries prior to microshunt implantation was 2.3 ± 1.3. After 1 year, the mean IOP was significantly reduced to 18.8 ± 4.6 mm Hg, with the mean number of medications significantly reduced to 1.4 ± 1.2. Complete success was achieved in 35% of eyes, and a qualified success in 60% of eyes. A decrease in IOP of at least 30% was found in 55% of eyes. Needling or bleb repair was performed in 49% of eyes. Complications were minimal and transient, except for one eye which presented with tube extrusion, and another eye with a transected tube. A repeat glaucoma surgery had to be performed in 17% of eyes. Conclusions: The Preserflo® Microshunt provided moderate success but a significant reduction in IOP, with a good safety profile after one year of follow-up in eyes at high risk for failure of filtering surgery.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Majoulet

Scemla

Hamard

et al. 2022

JCM

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“…Transient hypotony rates were lower in the PRESERFLO group (28.9% versus 49.6%; p < 0.01). Erosion, 72 malignant glaucoma 73 and endophthalmitis 74 have been reported.…”

Section: Preserflo Microshuntmentioning

confidence: 99%

The surgical management of glaucoma: A review

Lim

2022

Clinical Exper Ophthalmology

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After a long period of little change, glaucoma surgery has experienced a dramatic rise in the number of possible procedures in the last two decades. Glaucoma filtering surgeries with mitomycin C and glaucoma drainage devices remain the standard of surgical care. Other newer surgeries, some of which are minimally or microinvasive glaucoma surgeries, target existing trabecular outflow, enhance suprachoroidal outflow, create subconjunctival blebs, or reduce aqueous production. Some require the implantation of a device such as the iStent, Hydrus, Ex-PRESS, XEN and PRESERFLO, whilst others do not-Trabectome, Kahook dual blade, Ab interno canaloplasty, gonioscopy-assisted transluminal trabeculotomy, OMNI and excimer laser trabeculotomy. Others are a less destructive variation of an established procedure, such as micropulse transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cycloplasty. Cataract surgery alone can be a significant glaucoma operation. These older and newer glaucoma surgeries, their mechanism of action, efficacy and complications are the subject of this review.

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“…[11] Among the complications of PreserFlo, its exposure over the conjunctiva is a severe complication that increases the risk of foreign-body sensation and infection. [12][13][14][15] Reported potential risks in patients' backgrounds for microshunt exposure are the lack of Tenon capsule, [12,13] blepharitis, [12] loose Nylon suture, [14] and a history of multiple surgeries. [12][13][14][15] Intact conjunctiva and Tenon capsule are positive indications for PreserFlo microshunt surgery; however, the actual thickness and intensity of Tenon capsule or conjunctiva can be confirmed only during the surgery.…”

Section: Introductionmentioning

confidence: 99%

Scleral bridging technique for preventing PreserFlo microshunt exposure: A case report

Nakakura,

Nagata,

Fujisawa

et al. 2024

Medicine

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Introduction: The use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy. Patient concerns: However, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery. Diagnosis: Exfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva. Interventions: We performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge. Outcomes: The patient had better intraocular pressure control with positive cosmetic appearance using this technique. Conclusion: This technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.

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Trans-conjunctival Erosion of a Novel SIBS Microshunt After Revision Surgery Using Mitomycin C

Abstract: This article describes the first reported case of trans-conjunctival Preserflo microshunt erosion after revision surgery augmented with mitomycin C. Recommendations to avoid this complication include removal of original microshunt and limiting secondary application of mitomycin C.

Cited by 10 publications

References 13 publications

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

The surgical management of glaucoma: A review

Scleral bridging technique for preventing PreserFlo microshunt exposure: A case report

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