PRESERFLO Microshunt™ versus Non-Penetrating Deep Sclerectomy for Glaucoma Management, One-Year Results.

Purpose: To compare the short-term efficacy and safety of the PRESERFLO™ MicroShunt (PF) versus Non-Penetrating Deep Sclerectomy (NPDS) with Esnoper^®.

Methods: Retrospective comparative cohort study at a tertiary hospital including 79 eyes from 79 patients submitted to surgery (32 PF implantation, Group 1 and 47 NPDS, Group 2) between January 2022 and August 2023, with one year follow-up. Outcome measures included intraocular pressure (IOP), complications, surgical duration, postoperative major and minor interventions. Surgical failure was defined as IOP>21 mmHg or <20% reduction from baseline, IOP<5 mmHg, major postoperative intervention, or loss of light perception. Conversely, success was defined as the absence of these failure criteria: complete success without glaucoma medications, and qualified success with.

Results: Baseline characteristics, including age, sex, IOP, number of IOP-lowering medications, and visual field defects, were comparable between groups (p>0.05). After one year, IOP decreased significantly in both groups (PF: 20.13±6.20 to 15.00±3.15 mmHg; NPDS: 19.57±5.73 to 13.30±3.59 mmHg, both p<0.001). Complete success rates were 28.1% for PF and 40.4% for NPDS (p=0.189), while surgical failure was significantly higher in the PF group (65.6% vs 38.3%, p=0.015). Major reinterventions were more frequent with PF (10 vs 3, p=0.005), partly due to encapsulated blebs, while NPDS required more minor interventions (2 vs 17, p=0.002). Complication rates were similar (31.3% vs 14.9%, p=0.073), but surgical duration was shorter in the PF group (60.03±17.95 min vs 69.91±15.23 min, p=0.008).

Conclusion: PF and NPDS share comparable safety profiles. Although PF surgery is faster, it is associated with a higher rate of major postoperative interventions and failure. NPDS, while requiring more minor interventions, such as goniopuncture and needling, rarely demands major re-interventions. NPDS is known for its meticulous and technically challenging technique, but once mastered, it can result in fewer invasive re-interventions and improved efficacy.