Two-year outcomes of PRESERFLO MicroShunt implantation in a real-world heterogeneous glaucoma cohort: a retrospective single-center study.

PURPOSE: To evaluate intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), and safety outcomes after ab externo PRESERFLO MicroShunt (PreserFlo) implantation in routine clinical practice. METHODS: This retrospective single-center study included patients undergoing PreserFlo implantation (standalone or combined with phacoemulsification) between 2019 and 2022. IOP, BCVA, and glaucoma medications were collected preoperatively and postoperatively (day 1, week 1, month 1, year 1, and year 2). Hypotony was defined as IOP ≤ 5 mmHg. Complete success at 2 years required IOP ≤ 21 mmHg with ≥20% reduction from baseline without glaucoma medication. RESULTS: Eighty-one eyes of 74 patients (mean age 73.2 years) were included. Mean baseline IOP was 24.0 ± 10.2 mmHg, decreasing to 12.5 ± 3.8 mmHg at year 1 (p < 0.0001) and 13.5 ± 3.4 mmHg at year 2 (p = 0.0005). Mean BCVA was 0.63 ± 0.30 at baseline, 0.70 ± 0.31 at year 1, and 0.73 ± 0.27 at year 2, indicating stable visual acuity during follow-up. Mean IOP reduction was 39.6% at year 1 and 33.8% at year 2; 75.6% and 73.3% achieved ≥20% IOP reduction at years 1 and 2, respectively. Medications decreased from 3.09 ± 1.02 to 0.44 ± 0.97 (year 1) and 0.45 ± 0.85 (year 2), and their medication-free rates were 80.5% and 73.3%, respectively. Complications occurred in 55.6% of eyes; 27.2% required postoperative interventions (needling 20.9%); 15.0% required further glaucoma surgery. Complete success rates were 60.2% (year 1) and 52.0% (year 2). CONCLUSIONS: PreserFlo implantation provided sustained mid-term IOP reduction with substantial medication sparing and stable BCVA.