Management of Corneal Endothelial Failure in Eyes With a PreserFlo MicroShunt.

PURPOSE: To describe different approaches to manage corneal endothelial failure in eyes with PreserFlo MicroShunts (PFM). PATIENTS AND METHODS: All medical files (n = 150) of patients who had received PFM implantation between January 2022 and February 2024 at a single center were screened for corneal endothelial failure. Visual acuity, intraocular pressure, PFM position within the anterior chamber (distance to the endothelium and tube length), and central corneal thickness were recorded. Descemet membrane endothelial keratoplasty (DMEK) was performed with sulfur hexafluoride gas tamponade and combined with epithelial debridement to enhance visibility of intraocular structures. RESULTS: In total, 5 eyes with corneal edema in eyes with a PFM were identified, of which 3 eyes had received PFM implantation at our hospital (observed frequency: 3/150, 2%). One case was treated with shortening of the intracameral PFM portion and subsequent DMEK. In 2 cases, simultaneous shortening of the PFM and DMEK was performed. DMEK was technically feasible with early success in all cases. In one case, corneal edema resolved spontaneously after intraocular pressure reduction after needling of the filtering bleb and shortening of the PFM. The fifth patient refrained from corneal surgery because of multiple previous surgeries and reduced prognosis. CONCLUSIONS: Endothelial failure in eyes with PFM was observed mainly in eyes with further risk factors for endothelial impairment as Fuchs endothelial corneal dystrophy, pseudoexfoliation glaucoma, or multiple previous surgeries. DMEK with simultaneous or sequential intracameral tube shortening is a feasible option in this setting.