Expert panel provides consensus recommendations on use of PreserFlo microshunt device - Healio

A sheet of adept glaucoma surgeons reached statement connected diligent enactment and preoperative, perioperative and postoperative absorption with the PreserFlo microshunt drainage device.

“The accusation we gathered volition supply guidance for surgeons who privation to present this instrumentality successful their practice,” pb writer Anthony P. Khawaja, MD, PhD, told Healio/OSN.

Healio Interviews

The microshunt has been disposable successful Europe since 2019, and a bully fig of surgeons, geographically dispersed crossed Europe, person gathered acquisition with astatine slightest 100 cases. Most of them are besides acquainted with different drainage devices.

“We invited 12 of them to instrumentality portion successful a three-round modified Delphi panel,” Khawaja said.

The device

The PreserFlo microshunt (PMS, Santen) is simply a minimally invasive glaucoma surgical instrumentality that drains the aqueous wit to the subconjunctival space. It is designed to beryllium implanted ab externo, which is antithetic from the Xen gel stent (Allergan).

“You unfastened the conjunctiva and the Tenon’s and marque a pouch done which the microshunt is inserted. There are 2 tiny wings wrong it, positioned 4.5 mm from the tip, that assistance unafraid the instrumentality successful place,” Khawaja said.

The magnitude of the device, 8.5 mm, is besides an vantage due to the fact that it promotes a much posterior flow, and the bleb is acold back.

“These flatter and much posterior blebs are large and much amenable to interaction lens deterioration arsenic compared with trabeculectomy oregon Xen blebs,” Khawaja said.

The worldly is simply a synthetic polymer known arsenic SIBS, archetypal utilized successful coronary stents. It is simply a highly biocompatible and inert worldly that minimizes overseas assemblage absorption and is resistant to degradation.

Patient selection

All panelists were progressive successful 3 consecutive Delphi rounds betwixt September and December 2021. Consensus was acceptable astatine a predefined threshold of astatine slightest 70% of panelists. Full statement was achieved connected the usage of the PreserFlo to little IOP successful patients with superior open-angle glaucoma, specifically with IOP greater than 21 mm Hg.

“We each agreed that it is utile for radical who don’t person bully capable IOP power contempt maximum aesculapian therapy, radical who person problems with adherence oregon tolerance to treatment, and patients who person progressive ocular tract loss,” Khawaja said.

In addition, panelists agreed that the instrumentality mightiness beryllium utile successful patients with different forms of glaucoma, including pseudoexfoliation and pigment dispersion. They besides agreed that it is suitable for patients with precocious myopia, which is typically a comparative contraindication for trabeculectomy owed to the hazard for hypotony.

“Then, unsurprisingly, we each agreed that it should not beryllium utilized successful neovascular glaucoma, but determination wasn’t consensus, and we remained uncertain astir uveitic glaucoma and normal-tension glaucoma,” Khawaja said. “We besides stated that patients should ideally not person had incisional glaucoma country oregon cataract country wrong the past 6 months due to the fact that this whitethorn origin a beardown healing effect and perchance nonaccomplishment of the surgery.”

Surgical process

Perioperative considerations included the usage of mitomycin C, successful an country arsenic wide arsenic for trabeculectomy, to trim the hazard for subconjunctival fibrosis and summation the accidental of surgical success.

“Something absorbing for maine was that erstwhile I archetypal learnt, I was ever implanting the PMS astatine 12 o’clock, and present there’s a beardown statement that you should spell somewhat to 1 broadside oregon the other, astatine 11 oregon 1 o’clock, to debar the superior rectus muscle. Also, I enactment a small stitch to forestall the instrumentality from sticking up and getting caught astatine Tenon’s, but determination was nary statement connected that, and a batch of radical are inactive unsure astir whether that’s a bully idea,” Khawaja said.

Everyone agreed that the process is speedy to larn for surgeons who are utilized to performing trabeculectomy.

“You lone request to bash a fewer cases, and you’ll already beryllium precise bully astatine it, which mightiness not beryllium the lawsuit for immoderate different procedures,” Khawaja said.

Postoperative management

The bulk of panelists agreed that the follow-up play is much predictable arsenic compared with trabeculectomy and that, connected average, patients request less visits. Despite the cumulatively precocious measurement of surgeries, nary lawsuit of corneal endothelial decompensation was reported.

“We judge that, if that is simply a broadside effect, it is uncommon,” Khawaja said.

In lawsuit the microshunt fails, astir surgeons felt that they would spell for trabeculectomy.

“This is not thing I would personally do. I would astir apt spell consecutive to a full-size aqueous shunt. This is an country wherever we look guardant to much studies successful the aboriginal to spot however palmy a trabeculectomy is aft a PMS. Maybe past I’ll alteration my mind,” Khawaja said.

He looks guardant to further studies besides to clarify whether the PreserFlo whitethorn person a relation successful normal-tension glaucoma, erstwhile IOP is successful the precocious teens.

“And successful presumption of the surgical technique, it volition evolve, arsenic surgical techniques ever do. So, I deliberation we are going to delve deeper into this with a further statement sheet successful the adjacent future,” helium said.

For much information:

Anthony P. Khawaja, MD, PhD, tin beryllium reached astatine email: anthony.khawaja@ucl.ac.uk.