Novel Dual-Device Strategy: Failed PRESERFLO MicroShunt Connected to an Ahmed ClearPath - Case Report.

INTRODUCTION: The PRESERFLO® MicroShunt is an established filtrating surgery for moderate to advanced glaucoma, yet postoperative scarring may occur in up to one-third of cases, often requiring needling or revision. This case report describes a novel surgical approach in which a scar-compromised PRESERFLO® MicroShunt was connected to an Ahmed ClearPath® 250 mm2 implant to enhance aqueous outflow without introducing an additional tube into the anterior chamber. CASE PRESENTATION: A 64-year-old patient with advanced primary open-angle glaucoma and recurrent scarring after PRESERFLO® implantation underwent this combined procedure. To revive the failed PRESERFLO® MicroShunt, the Ahmed ClearPath® was used as an extension to the MicroShunt: the tube of the Ahmed ClearPath® was inserted into the PRESERFLO® MicroShunt and secured with a cross suture, followed by coverage with a scleral patch graft. Intraocular pressure decreased to 5-9 mm Hg and remained stable under minimal medication (dorzolamide eyedrops 3×/d) at the 3 months postoperative follow-up visit. CONCLUSION: This is the first case report that describes the outcome of the connection of the PRESERFLO® MicroShunt to an Ahmed ClearPath®. The described dual-device strategy preserved conjunctival tissue and obviated the need for a second tube in the anterior chamber. This approach represents an effective and tissue-sparing alternative for patients in whom a PRESERFLO® MicroShunt is well positioned but rendered insufficient by scarring.