PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature

 

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Abstract

The PRESERFLO^™ MicroShunt (MP; Santen Inc., Osaka, Japan) is a minimally invasive bleb surgery (MIBS) manufactured to treat primary open-angle glaucoma (POAG), with lower postoperative adverse effects than with conventional filtering surgeries. We describe here the case study of a 58-year-old woman who presented with bilateral severe myopia with bilateral advanced POAG and unreached target pressure under quadritherapy, who was successfully managed by PM surgery. A review of the literature completes our observation. At presentation, the patient had a spherical equivalent of − 7.50 RE and − 7.75 LE with an IOP of 22 mmHg right and left eye (RLE) under quadritherapy, and with severe bilateral visual field loss, including scotomas within the central 5°. The patient presented with systemic hypertension treated with an antihypertensive drug. Two selective laser trabeculoplasties (SLT), performed 3 months apart, were first tried on the LE, without any change in IOP at 2 months. After considering the high risk of postoperative complications, a PM operation was proposed, with a targeted IOP in the mid-fifteens RLE. The patientʼs eyes underwent PM surgery with mitomycin C (MMC) MMC0.2 mg/mL for 3 minutes without any complications. The LE required 2 consecutive needlings with 1 mL MMC0.2 mg/mL. At 24 months after surgery, the two eyes gave successful results without the need for any additional medical therapy, and with well-functioning conjunctival blebs. The PM was an effective alternative to the gold standard trabeculectomy in our severely myopic patient. A comparative study between conventional filtering operations and this MIBS in highly myopic patients would confirm our observation.

Zusammenfassung

Der PRESERFLO^™ MicroShunt (MP; Santen Inc., Osaka, Japan) ist eine minimalinvasive Bleb-Chirurgie (MIBS) zur Behandlung des primären Offenwinkelglaukoms (POWG), mit geringeren postoperativen Nebenwirkungen als bei konventionellen Filteroperationen. Wir beschreiben hier die Fallstudie einer 58-jährigen Frau, die sich mit beidseitiger schwerer Myopie mit beidseitigem fortgeschrittenem POWG und unerreichtem Zieldruck unter Quadritherapie vorstellte und erfolgreich mit der PM-Chirurgie behandelt wurde. Eine Überprüfung der Literatur vervollständigt unsere Beobachtung. Bei der Vorstellung hatte die Patientin ein sphärisches Äquivalent von − 7,50 am rechten Auge (RA) und − 7,75 am linken Auge (LA) mit einem IOD von 22 mmHg am RA und LA unter Quadritherapie und mit schweren beidseitigen Gesichtsfeldausfällen, einschl. Skotomen innerhalb der zentralen 5°. Die Patientin hatte eine systemische Hypertonie, die mit einem blutdrucksenkenden Medikament behandelt wurde. Zwei selektive Lasertrabekuloplastiken (SLTs), die im Abstand von 3 Monaten durchgeführt wurden, wurden zunächst am LA versucht, ohne dass sich der IOD nach 2 Monaten änderte. In Anbetracht des hohen Risikos postoperativer Komplikationen wurde eine PM-Operation vorgeschlagen, wobei ein IOD von etwa 15 mmHg am RA und LA angestrebt wurde. Die Augen der Patientin wurden einer PM-Operation mit Mitomycin C (MMC) 0,2 mg/ml für 3 min unterzogen, ohne dass es zu Komplikationen kam. Das LA erforderte 2 aufeinanderfolgende Nadelstiche mit 1 ml MMC0,2 mg/ml. 24 Monate nach der Operation zeigten beide Augen erfolgreiche Ergebnisse, ohne dass eine zusätzliche medikamentöse Therapie erforderlich war, und mit gut funktionierenden Bindehautblasen. Die PM war eine wirksame Alternative zum Goldstandard Trabekulektomie bei unserer stark myopen Patientin. Eine vergleichende Studie zwischen konventionellen Filteroperationen und dieser MIBS bei stark myopen Patienten würde unsere Beobachtung bestätigen.

Publication History

Received: 29 October 2023

Accepted: 18 December 2023

Article published online:
23 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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