Précis: PreserFlo ® MicroShunt implantation alone may be well tolerated for the corneal endothelium across glaucoma subtypes over 12 months, whereas combination with cataract extraction may increase the risk of endothelial compromise, with a tendency toward a more pronounced reduction in pseudoexfoliation glaucoma. Purpose: To evaluate the impact of PreserFlo ® MicroShunt (PMS) implantation on corneal endothelial cell density (ECD) over 12 months, stratified by glaucoma subtype and surgical procedure. Patients and Methods: This retrospective cohort study included 103 eyes with primary open-angle glaucoma, pseudoexfoliation glaucoma (PEXG), and secondary open-angle glaucoma without PEXG, all undergoing PMS implantation (either alone or combined with cataract extraction PMS-CE) between August 2022 and December 2023. Changes in ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX) were assessed. Firth logistic regression was employed to evaluate risk factors for >10% ECD loss. Subgroup analyses were performed by surgical procedure. Results: No significant within-group ECD, CV, or HEX changes were observed at 12 months in any glaucoma subtype. Thirteen eyes (12.6%) exhibited >10% ECD loss, predominantly in the PMS-CE group. Multivariate analysis identified PMS-CE as a significant risk factor (odds ratio OR: 12.1; 95% confidence interval CI: 2.69–75.0; P <0.001). In the PMS-CE subgroup, PEXG was associated with greater risk of ECD loss (OR: 9.39; CI: 1.19–125.0; P =0.033). Conclusions: PMS-alone demonstrated a favorable safety profile for the corneal endothelium across glaucoma subtypes. However, PMS-CE may pose an elevated risk of endothelial compromise, with a tendency toward a more pronounced reduction in PEXG eyes.
Okada et al. (Mon,) studied this question.