Preserflo Microshunt Implant In Refractory Uveitic Glaucoma

Uveitic glaucoma still represents a clinical challenge. Patients with uveitic glaucoma usually respond less to medical therapy and have a higher risk of complications following surgical interventions. Our purpose is to highlight the challenges associated with management of refractory uveitic glaucoma and the potential use of Minimally Invasive Glaucoma Surgery (MIGS), such as Preserflo microshunt implant, in those cases.

Hospital Garcia de Orta

A 46-year-old caucasian male with prior history of Multiple Sclerosis presented to the ophthalmology clinic for recurrent anterior nongranulomatous uveitis. During treatment and follow-up, persistent high intraocular pressure was noted. Computerized static perimetry and optical coherence tomography both showed glaucomatous changes. The patient started topical therapy for glaucoma, but despite best medical treatment, the patient maintained intraocular hypertension and structural and functional testing showed disease progression. From this point, surgical strategies were discussed.

The surgical team proceeded to implant an Ahmed valve bilaterally. No complications occurred during the procedure. During follow-up, valve tube exposure was noted. A cornea patch graft to cover the valve tube was attempted, but exposure persisted, and the valve had to be removed. Given the persistent intraocular hypertension, a Preserflo microshunt implant was placed on the right eye, maintaining the functioning valve on the left eye. The surgical implantation of the microshunt was successful and on postoperative right eye examination, a formed bleb was identified. After six months, right eye intraocular pressure was 12 mmHg without any medical therapy for glaucoma. 

Patients with uveitic glaucoma have a higher risk of medical therapy failure and require alternative strategies for maintaining target values of intraocular pressure. Nevertheless, recurrent inflammation represents an additional challenge for glaucoma surgery in these patients, as it increases the risk of fibrosis and valve malfunction and eventual failure. Our case shows that despite the difficulties that uveitic glaucoma may impose, Minimally Invasive Glaucoma Surgery (MIGS) such as Preserflo microshunt implant can be a suitable alternative when other strategies fail.