One-Year Safety, Efficacy, And Postoperative Follow-Up Burden After Trabeculectomy, Non-Penetrating Deep Sclerectomy, And Preserflo® Microshunt With Mitomycin-C (0.2 Vs 0.4 Mg/Ml): A Two-Center, 100-Eye Retrospective Cohort Study

To compare 12‑month intraocular pressure (IOP) control, glaucoma medication burden, postoperative maneuvers, and complications among trabeculectomy + mitomycin‑C (MMC) 0.2 mg/mL, non‑penetrating deep sclerectomy (NPDS) + MMC 0.2 mg/mL, and PRESERFLO® MicroShunt implantation with MMC 0.2 versus 0.4 mg/mL.

Two-center retrospective cohort study of 100 eyes undergoing trabeculectomy+MMC 0.2 mg/mL (n=21), NPDS+MMC 0.2 (n=44), or PRESERFLO MicroShunt with MMC 0.2 (n=16) or 0.4 (n=19). The primary endpoint was 12-month IOP; medication use, postoperative maneuvers, complications, and success were also assessed.

Two-center retrospective cohort study (Centre Hospitalier Sud Francilien [CHSF] and Institut Laser d'Ophtalmologie - Paris XVème) including 100 eyes (MicroShunt + MMC 0.2, n=16; MicroShunt + MMC 0.4, n=19; NPDS + MMC 0.2, n=44; trabeculectomy + MMC 0.2, n=21). The primary endpoint was IOP at 12 months (available for 95 eyes). Outcome status at 12 months was coded as complete success (IOP ≤18 mmHg without medications), qualified success (IOP ≤18 mmHg with medications), or surgical failure (IOP >18 mmHg and/or major re‑intervention). Between‑group comparisons used Kruskal–Wallis or χ²/Fisher tests; within‑group changes used Wilcoxon signed‑rank tests. Kaplan–Meier curves described time‑to‑failure for complete and overall success.

One hundred eyes (71 patients) were analyzed. Baseline IOP differed significantly between groups (p<0.001), with the highest values in the trabeculectomy group. At 12 months, IOP decreased significantly in all groups (all p≤0.005), with no between-group difference in final IOP (p=0.498); median values ranged from 12.0 to 14.5 mmHg. Medication burden declined from about 3.3–3.6 classes to 0.0–0.5 (all p<0.001). Complete success rates ranged from 81.2% to 94.7% (p=0.750). Postoperative maneuvers differed significantly (p=0.007), lowest with MicroShunt + MMC 0.4, while Dellen was observed exclusively in this group.

All four procedures achieved mid‑teen IOP and major medication reduction at 12 months. However, postoperative care burden and specific safety signals differed across techniques and MMC concentrations. In this real‑world cohort, MicroShunt + MMC 0.4 showed the lowest postoperative maneuver rate but a signal for ocular‑surface events (Dellen), underscoring the need for individualized antifibrotic strategy and close early follow‑up. Prospective comparative studies are needed to confirm these findings and better define procedure‑specific trade‑offs.