PreserFlo MicroShunt vs. trabeculectomy in patients with uncontrolled glaucoma

Summary Introduction Glaucoma is one of the leading causes of irreversible blindness, posing a growing global challenge. Trabeculectomy (TE) remains the gold standard in glaucoma surgery, while alternative procedures such as the PreserFlo MicroShunt (PF; Santen Inc., Osaka, Japan) have a lower risk profile and offer comparable intraocular pressure (IOP) reduction. Methods This retrospective study analyzed 204 eyes of patients undergoing either trabeculectomy or PreserFlo implantation. The primary endpoint was the change in IOP, while secondary endpoints included postoperative complications, needling rates, and revision procedures. Data were collected over 1 year for statistical analysis. Results Both procedures resulted in significant IOP reduction and stabilization of the peripapillary retinal nerve fiber layer (RNFL). Postoperative hypotony was more common after trabeculectomy at 1 week (TE: 22.2% vs. PF: 16.3%), while needling interventions were more frequent with PreserFlo (PF: 52.5% vs. TE: 35.9%). No significant difference in long-term IOP control was observed. Conclusion Both trabeculectomy and the PreserFlo MicroShunt are effective for IOP control. PreserFlo has a lower risk of postoperative complications but requires more frequent additional interventions. These findings highlight the importance of individualized treatment decisions based on patient-specific factors.