Preserflo Microshunt Insertion Into The Cilliary Sulcus

To report on the option and technique and clinical advantage of the Preserflo MicroShunt insertion into the posterior chamber ciliary sulcus 

The procedure was performed at the Glaucoma Unit of the Ophthalmology Department at Hillel Yaffe Medical Center on a 64-year-old advanced pseudoexfoliation glaucoma patient which despite maximal tolerated medical therapy and two failed glaucoma surgeries, still suffered from uncontrolled intraocular pressure .

A fornix-based conjunctival flap was fashioned in the superior-nasal quadrant of the left eye. The episclera and sclera were treated with 0.4 mg/mL mitomycin C for 3 minutes. A scleral tunnel was initiated 3 mm posterior to the limbus. A 25 G angled needle was then introduced, directed towards the ciliary sulcus at a steeper angle than typical anterior chamber implantations, targeting the area beneath the iris plane.

Postoperatively, the patient’s intraocular pressure (IOP) decreased to 6 mm Hg on the first postoperative day and stabilized at 11 mm Hg at the 6-month follow-up. A robust, posteriorly located filtering bleb was observed, and the patient successfully discontinued all topical glaucoma medications. The endothelial cell (EC) count remained stable, with no evidence of corneal edema. Notably, there were no significant postoperative complications encountered.

The implantation of the Preserflo MicroShunt into the ciliary sulcus demonstrates a promising intervention for patients at high risk of corneal decompensation. This technique offers effective intraocular pressure (IOP) control while preserving endothelial cell (EC) count and minimizing the risk of postoperative complications