Outcomes Of Preserflo Microshunt Implantation In Refractory Uveitic Glaucoma: A Retrospective Case Series

To evaluate the safety and efficacy of the PreserFlo MicroShunt (PMS) in eyes with refractory uveitic glaucoma (UG). Uveitic glaucoma is often difficult to manage due to persistent inflammation, fibrosis risk, and corticosteroid-related intraocular pressure (IOP) elevation. Traditional filtering surgery carries a higher complication profile in this population. This study aimed to assess surgical success, IOP reduction, medication burden, visual acuity outcomes, and postoperative complications following PMS implantation in a real-world cohort of patients with refractory UG.

Single-center retrospective case series conducted at a tertiary referral ophthalmology department. All surgeries were performed by an experienced glaucoma surgeon between January 2021 and March 2025. The study adhered to the Declaration of Helsinki and received institutional ethics committee approval.

Thirteen eyes of 12 patients with refractory uveitic glaucoma underwent PreserFlo MicroShunt implantation with adjunctive mitomycin C. Only clinically inactive uveitis (≥3 months) was included. Surgical success was defined according to Primary Tube Versus Trabeculectomy (PTVT) criteria. Primary outcome was cumulative surgical success at ≥6 months. Secondary outcomes included IOP, number of glaucoma medications, visual acuity (VA), complications, and need for additional surgery. Statistical analysis was performed using repeated measures ANOVA and independent samples tests.

Mean follow-up was 17.9 ± 10.8 months. Complete success was achieved in 53.8% of eyes, and cumulative success (complete + qualified) in 76.9%. Mean IOP decreased from 24.9 ± 6.0 mmHg preoperatively to 16.1 ± 8.5 mmHg at final follow-up (p < 0.001). The number of glaucoma medications decreased from 3.8 ± 0.6 to 0.8 ± 1.1 (p < 0.001). Visual acuity remained stable overall. Early and late postoperative complications were mostly mild and manageable. Two eyes required Baerveldt implantation due to insufficient IOP control. No sight-threatening complications occurred.

PreserFlo MicroShunt implantation provided clinically meaningful IOP reduction and decreased medication burden in refractory uveitic glaucoma, with an acceptable safety profile. Although success rates were lower than those typically reported in primary open-angle glaucoma, outcomes were comparable to previous uveitic series. Complications were generally manageable. PMS may represent a viable surgical option in carefully selected uveitic glaucoma patients; however, larger prospective multicenter studies with longer follow-up are required to better define its long-term performance in this challenging population.