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RCOphth Annual Congress 2026
18 - 21 May, 2026 | Manchester Central, Manchester
P123
Real-world three-year comparison of Preserflo Microshunt with Augmented trabeculectomy.
Poster Presenter
Part of Topic
Glaucoma
Introduction / Background:
Trabeculectomy is considered the gold standard surgical treatment for glaucoma. Its ability to reduce intraocular pressure (IOP) over a sustained period is backed by ample clinical evidence and over 50 years of clinical practice. However, the operation is invasive. Surgical complications are not uncommon, thus necessitating frequent follow-up.
Minimally invasive bleb surgery (MIBS) procedures, such as the Preserflo Microshunt, have been adopted more recently, with a correspondingly smaller but ever-increasing evidence base. However, as a less invasive procedure, its benefits include good IOP reduction with reduced rates of complications and requirement for post-operative follow-up. As much of the evidence derives from randomised control trials, this study aims to provide real world evidence on the outcomes of trabeculectomy and Preserflo in a tertiary glaucoma setting.
Methods:
This retrospective observational study included all patients who underwent trabeculectomy or MIBS (Preserflo) at the Princess Alexandra Eye Pavilion (PAEP) during a one-year period from 16/05/2022 to 15/05/2023. Clinical outcomes were assessed over a 24-month follow-up period. The effectiveness outcomes include success rate (≥20% IOP reduction), absolute IOP reduction, decrease in number of anti-glaucoma medication and the percentage of patients who remained medication-free.
Results:
136 eyes of 125 patients received surgical glaucoma intervention during the study period. 89 eyes of 84 patients (age 67.4 ± 12.8, n = 54 male, 64%) underwent trabeculectomy while 47 eyes of 41 patients (age 70.3 ± 13.7, n = 20 male, 49%) underwent PreserFlo (p-value 0.22). At the end of the 2-year follow-up period, the trabeculectomy cohort had a 91% success rate, while the PreserFlo cohort had a 77% success rate. The trabeculectomy cohort achieved an absolute IOP reduction of -13.3 ± 8.6 while the PreserFlo cohort achieved a reduction of -14.5 ± 10.5 (p-value 0.22). The trabeculectomy cohort reduced the number of anti-glaucoma medication by 2.2 ± 1.3 while the Preserflo cohort reduced by 1.5 ±1.5 (p-value 0.002). 80% of trabeculectomy cohort remained medication-free while only 47% of PreserFlo cohort achieved this status. For adverse effects, 6% of trabeculectomy cohort and 15% of PreserFlo cohort required re-operation. 6% of trabeculectomy cohort and none of PreserFlo cohort experienced hypotony post-op. (p-value 0.16) Trabeculectomy cohort returned to clinic for 13.2 ± 4.4 appointments, while PreserFlo cohort had 8.2± 1.9 appointments during the 2-year follow-up period. (p-value < 0.01)
Conclusion:
This is the real-world retrospective collection of data for these two groups of patients. The results show trabeculectomy as more effective in achieving target IOP with better qualified and complete success but with more follow up visits and higher manipulation. Preserflo microshunt requires fewer post op follow-up appointments, but less effective in achieving target IOP than the trabeculectomy group, but rates of complication and specifically hypotony were lower in the Preserflo group, though the difference was not statistically significant.