Title : Procedures in primary open-angle glaucoma: A review of outcomes of preserflo microshunt compared to trabeculectomy
Abstract:
Introduction: This study compared the outcomes of the Preserflo microshunt to trabeculectomy in patients diagnosed with primary open-angle glaucoma (POAG). The primary outcomes analyzed were post-operative intraocular pressure (IOP) and the medication burden following each surgical intervention. POAG is characterized by elevated IOP, which can lead to progressive optic nerve damage and subsequent vision loss. While trabeculectomy is considered the gold standard for treating moderate to severe glaucoma, the Preserflo microshunt represents a potential alternative approach that warrants consideration.
Methods: A literature search was conducted utilizing Medline and Embase to identify studies comparing the efficacy of the Preserflo microshunt and trabeculectomy. The analysis focused on data regarding the reduction in intraocular pressure (IOP) and the decrease in medication burden following these surgical procedures.
Results: In a two-year randomized controlled trial (RCT), the PreserFlo group experienced a decrease in pre-operative intraocular pressure (IOP) from 21.1 ± 4.9 mmHg to 14.3 ± 4.3 mmHg at one year, with a reduction in medication usage from 3.1 ± 1.0 to 0.6 ± 1.1. In the trabeculectomy group, IOP reduced from 21.1 ± 5.0 mmHg to 11.1 ± 4.3 mmHg, and medication usage decreased from 3.0 ± 0.9 to 0.3 ± 0.9.
A retrospective study reported that mean IOP decreased from 24.09 ± 1.15 mmHg to 11.37 ± 1.13 mmHg and from 21.67 ± 0.77 mmHg to 15.50 ± 1.54 mmHg in the trabeculectomy and PreserFlo groups, respectively. The mean number of IOP-lowering medications decreased from 3.25 ± 0.14 to 0.53 ± 0.14 in the trabeculectomy group and from 3.51 ± 0.14 to 1.06 ± 0.43 in the PreserFlo group.
In another prospective interventional cohort study over one year, IOP in the PreserFlo group decreased from 16.2 (13.8-21.5) to 10.5 (8.9-13.5) mmHg, and in the trabeculectomy group from 17.6 (15.6-24.0) to 11.1 (9.5-12.3) mmHg, with both groups achieving these reductions without additional medications. The number of medications used decreased from 4 to 0 in both groups.
In a prospective study of 300 patients, 12-month post-operative IOP averaged 12.89 ± 3.4 mmHg in the PreserFlo group and 11.39 ± 4.5 mmHg in the trabeculectomy group, both significantly lower than baseline (23.47 ± 8.36 mmHg and 22.03 ± 5.2 mmHg, respectively). Medication usage reduced to 0.4 ± 0.8 in the PreserFlo group and to 0 in the trabeculectomy group, from baseline values of 2.5 ± 1.2 and 2.7 ± 0.9, respectively.
Conclusion: A review of studies comparing PreserFlo and trabeculectomy across various publications indicate that, although trabeculectomy alone is capable of significantly reducing intraocular pressure (IOP) in moderate to severe glaucoma cases, PreserFlo also achieves significant IOP reduction, albeit to a lesser extent than trabeculectomy. However, the reduction in medication burden was more pronounced in patients receiving PreserFlo.
