Novel Surgical Approach To Correct Late-Hypotony In Preserflo Microshunt

This work reports a novel surgical approach for addressing late hypotony in PreserFlo MicroShunt® blebs. Hypotony is a well-known complication of glaucoma filtering surgery. Most surgical strategies proposed, such as rip-cord suturing or intraluminal stenting, aim to address early postoperative hypotony. In contrast, surgical techniques for late hypoton remain limited. We present a novel surgical approach that is effective, relatively easy to perform, and safe.

Ophthalmology Department of Hospital de Santa Maria, a tertiary reference hospital in Lisbon, Portugal.

We report two cases of patients with uveitic glaucoma with late hypotony due to suspected ciliary body shutdown several months after PreserFlo MicroShunt® implantation. Both patients were successfully treated using a novel surgical technique. Under local anesthesia, several interrupted 10-0 nylon sutures were placed in the bleb region to reduce its size and sectorize it, creating an iatrogenic “ring of steel”, effectively solving the hypotony.

After treatment, both patient’s IOP returned to normal levels and remained stable without needing topical hypotensive medications.

This new bleb compartmentalization method proved effective and safe for solving late hypotony.