What question did this study set out to answer?

The aim is to evaluate the effectiveness of intraoperative nylon thread insertion in preventing hypotony-related complications after PreserFlo MicroShunt implantation.

April 18, 2026Clinical ophthalmology0 citationsOpen Access

Efficacy of Intraoperative 9-0 Nylon Thread Insertion for Preventing Hypotony-Related Complications Following PreserFlo MicroShunt Implantation in Japanese Patients: A Comparative Study

TMTakahiro MatsuokaHamamatsu University School of Medicine TUTakahiro UsamiHamamatsu University School of Medicine 金弘金子弘樹Hamamatsu University School of Medicine

Key Points

The aim is to evaluate the effectiveness of intraoperative nylon thread insertion in preventing hypotony-related complications after PreserFlo MicroShunt implantation.
Retrospective comparative study of 81 eyes from 63 patients
Patients divided into NTI group (59 eyes) and Non-NTI group (22 eyes)
Evaluated incidence of hypotony-related complications over 6-month follow-up
Assessed intraocular pressure changes and medication score reduction
Used cluster correction for statistical analyses
NTI group showed significantly lower hypotony-related complications (11.9% vs 54.5%, p< 0.001)
Kaplan-Meier analysis indicated better complication-free survival in the NTI group (log-rank p< 0.001)
Median IOP on postoperative day 1 was higher in NTI group (10.0 mmHg vs 5.8 mmHg, p< 0.001)
At 6 months, both groups had similar IOP control (p=0.324) and medication-free rates (p=0.190)

Abstract

Background: Early postoperative hypotony remains a significant complication following PreserFlo MicroShunt (PMS) implantation, potentially leading to serious sequelae including choroidal detachment and hypotensive maculopathy. This study evaluated the effectiveness of intraoperative 9– 0 nylon thread insertion (NTI) technique in preventing hypotony-related complications. Methods: This retrospective comparative study included 81 eyes of 63 patients who underwent PMS implantation with mitomycin C between September 2023 and June 2025. Eyes were divided into NTI group (59 eyes, 42 patients) and Non-NTI group (22 eyes, 21 patients). The primary outcome was the incidence of composite hypotony-related complications (choroidal detachment and/or hypotensive maculopathy) during 6-month follow-up. Secondary outcomes included intraocular pressure (IOP) changes, medication score reduction, and timing of suture removal. Statistical analyses incorporated cluster correction for bilateral cases. Results: Baseline characteristics, including glaucoma subtype distribution, were comparable between groups. The composite hypotony-related complication rate was significantly lower in the NTI group (11.9% vs 54.5%, p< 0.001; odds ratio 0.112, 95% CI 0.039– 0.321). Kaplan-Meier analysis demonstrated superior complication-free survival in the NTI group (log-rank p< 0.001, hazard ratio 0.094, 95% CI 0.035– 0.252). The median IOP at postoperative day 1 was significantly higher in the NTI group (10.0 8.0– 14.0 vs 5.8 5.0– 8.5 mmHg, p< 0.001), indicating effective early hypotony prevention. At 6 months, both groups achieved comparable IOP control (13.0 10.9– 14.0 vs 13.0 11.0– 16.0 mmHg, p=0.324) with medication-free rates of 74.6% and 59.1%, respectively (p=0.190). Conclusion: Intraoperative 9– 0 nylon thread insertion significantly reduces hypotony-related complications following PMS implantation without compromising IOP control at 6 months or medication reduction, representing a safe and effective surgical modification. Keywords: PreserFlo MicroShunt, glaucoma surgery, hypotony prevention, nylon thread insertion, choroidal detachment, hypotensive maculopathy

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