Two-Year Real-World Outcomes Of Preserflo™ Microshunt Implantation: World Glaucoma Association-Defined Success Rates And Comparative Analysis Of Standalone Versus Combined Phacoemulsification Procedures

To evaluate the two-year effectiveness and safety of PreserFlo™ MicroShunt implantation in a real-world glaucoma cohort, defining surgical success according to World Glaucoma Association (WGA) criteria and comparing outcomes between standalone procedures and those combined with phacoemulsification.

Single-center retrospective cohort study.

Thirty-nine consecutive eyes undergoing PreserFlo™ MicroShunt implantation (21 standalone, 18 combined with phacoemulsification) were analyzed. Primary outcomes at 24 months included intraocular pressure (IOP), antiglaucoma medication burden, and surgical success per WGA criteria (IOP 6–21 mmHg, ≥20% reduction from baseline, no glaucoma reoperation). Complete success required no medications; qualified success allowed topical therapy. Secondary outcomes included complications, reinterventions, and Kaplan–Meier survival analysis.

Mean IOP decreased from 23.1 ± 6.5 to 14.3 ± 3.6 mmHg at 24 months (37.9% reduction; p0.001), with medication classes reducing from 3.6 ± 1.3 to 0.5 ± 0.8 (86.1% reduction; p0.001). Overall surgical success was 64.5% (complete: 54.8%; qualified: 9.7%). 

Standalone surgery achieved lower IOP than combined procedures (12.9 ± 2.8 vs 16.6 ± 3.9 mmHg; p=0.004) and higher complete success rates (76.2% vs 40.0%; p=0.106). Complications occurred in 53.8% of eyes (transient hypotony 15.4%, hyphema 10.3%). Needling was required in 12.8% and additional glaucoma surgery in 15.4%.

PreserFlo™ MicroShunt implantation achieves sustained and clinically meaningful IOP reduction with substantial decrease in medication burden at two years in real-world clinical practice. WGA-defined surgical success rates are consistent with published evidence from controlled studies. Standalone procedures demonstrated superior IOP control compared with combined phacoemulsification surgery, suggesting potential benefits of staged approaches in selected patients. The safety profile aligns with conventional filtering surgery, supporting PreserFlo™ MicroShunt as an effective minimally invasive surgical option for long-term glaucoma management.