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The PRESERFLOTMMicroShunt (Santen, Osaka, Japan) is a new ab-externo, subconjunctival, minimally invasive glaucoma drainage device for surgical treatment of patients with early to advanced primary open angle glaucoma. It is made of a new polymer, ‘SIBS’ (poly[styrene-block-isobutylene-block-styrene]), and consists of an 8.5-mm long tube with an outer diameter of 350 μm and a lumen diameter of 70 μm. Placement of the device is combined with intraoperative application of mitomycin C (MMC). The MicroShunt received the CE Mark in 2012 but was only released for sale in the European market in 2019. Outside Europe, the device is currently being tested in Canada, Singapore, the USA and the Dominican Republic. Published evidence is still limited; however, study results to date show that a mean intraocular pressure (IOP) reduction of 30–55% from baseline can be achieved, with a substantial reduction in glaucoma medications. Current studies also suggest that an MMC concentration of 0.4 mg/mL is more effective than 0.2 mg/mL. Success rates (i.e., no failures [IOP ≥21 mmHg or <20% IOP reduction] with or without glaucoma medication) were found to vary between 80–100% at 1–2 years of followup. Adverse events (e.g. hyphema, hypotony, shallow anterior chamber or choroidal effusion in 10–25% of cases) were mild. They usually occurred within the first postoperative week and spontaneously resolved within 1–3 months. No long-term sight-threatening complications have been reported so far. Patients are usually satisfied with the procedure. Although more robust data are needed, these first studies suggest that the PRESERFLO MicroShunt is a promising new, minimally invasive procedure for glaucoma.

Minimally Invasive Glaucoma Surgery with a New Ab-externo Subconjunctival Bypass – Current Status and Review of Literature