PRESERFLO® MicroShunt 2025 Patient Guide | Safe Glaucoma Pressure Control in Manila

Published by Dr. Manolette Roque at May 4, 2025

ANIMATION

PRESERFLO

Key Learning Points

Glaucoma silently damages the optic nerve by raising intra‑ocular pressure (IOP).
PRESERFLO MicroShunt is a micro‑invasive implant that diverts fluid under the conjunctiva, often cutting pressure by 30–45 %.
The surgery is brief, suture‑free, and bleb‑forming, offering a gentler option than trabeculectomy while sparing the eye’s natural anatomy.
Most patients resume light activities within one week, with less post‑op drop burden than traditional filtering surgery.
Long‑term data (five‑year follow‑up) confirm sustained pressure reduction and medication relief in many eyes.

Introduction – A Quiet Solution for Loud Pressure

Imagine your eye as a kitchen sink. Fluid (aqueous humor) should flow in and drain out freely. In open‑angle glaucoma, the drain clogs, and pressure builds—much like water backing up. The PRESERFLO MicroShunt is a hair‑thin “overflow pipe” that quietly carries excess fluid outside the eye before damage occurs.

1. Understanding Glaucoma in Everyday Terms

Glaucoma is a family of diseases that slowly steal side vision. Think of the optic nerve as a fiber‑optic cable; too much pressure crushes those delicate wires. Symptoms are rarely felt until damage is advanced, which is why half of people with glaucoma don’t know they have it.

Common Signs

Gradual loss of peripheral vision
Needing more light to read
Blind spots or tunnel vision (late)
Acute angle‑closure warning signs: sudden eye pain, redness, nausea, blurry vision—seek help immediately!

2. Traditional Treatments and Their Limits

Treatment	How it Works	Limitations
Eye‑drop medications	Reduce fluid production or boost drainage	Lifelong use; side effects; adherence issues
Selective Laser Trabeculoplasty (SLT)	Laser “pokes” tiny holes in the drain	Effect wanes 2‑5 years
Trabeculectomy	Creates new drainage tunnel under a scleral flap	Effective but higher risk of leaks, infections, blurred vision

3. Why MIGS Was Invented

Minimally Invasive Glaucoma Surgery (MIGS) fills the gap between drops/laser and more aggressive filtering surgery. Devices are implanted through tiny incisions with minimal tissue disruption, shortening recovery and reducing complication rates.

4. Meet the PRESERFLO® MicroShunt

Design Highlights

Material: SIBS (poly(styrene‑block‑isobutylene‑block‑styrene))—biocompatible, long‑lasting.
Size: 8.5 mm long; internal lumen 70 µm (about a human hair).
Placement: From the anterior chamber to the subconjunctival space forming a filtering “bleb.”
Regulatory status: CE‑marked in Europe; FDA approval pending as of May 2025. Globally adopted in >45 countries.

How It Works (Garden‑Hose Analogy)

Picture pressure building in your garden hose. By installing a tiny side outlet, water diverts smoothly into the flower bed instead of bursting the hose. PRESERFLO quietly drains aqueous fluid under the conjunctiva where it is absorbed by surrounding tissues.

5. Who Is a Good Candidate?

Ideal:

Primary open‑angle glaucoma (mild → moderate, or uncontrolled on drops)
Pseudophakic (already had cataract surgery) or combined cataract + MicroShunt cases
Patients seeking drop reduction

Not ideal / caution:

Angle‑closure without prior iridotomy
Active ocular inflammation or infection
Conjunctival scarring from previous surgery

Your ophthalmologist will weigh optic‑nerve damage, target pressure, and ocular surface health before recommending the device.

6. Step‑by‑Step Surgical Journey

Timeline	What Happens	Tips for You
Pre‑op day	Stop blood thinners if advised; antibiotic drops started	Arrange a companion for ride home
Operating room (≈15 min)	Local anesthetic; 3‑mm subconjunctival pocket; MicroShunt primed with balanced saline; inserted 3 mm posterior to limbus; Tenon’s closed with dissolving stitch	You won’t feel pain, only mild pressure
First 24 h	Clear shield, steroid/antibiotic drops hourly, rest	Keep head slightly elevated, don’t rub
Week 1	Vision hazy then clearing; pressure check	Light chores OK; avoid lifting >10 kg
Month 1–3	Steroids tapered; possible bleb‑needling if pressure rises	Use drops exactly as prescribed
Month 6+	Expect drop burden cut by ≥1–2 medications; pressure stable	Resume swimming after surgeon approval

7. Expected Benefits and Evidence

IOP reduction 30–45 % at 12 months with medication reduction by 1.9 drops.
Five‑year follow‑up shows sustained pressure control; ~1/3 required a touch‑up procedure, similar to trabeculectomy touch‑up rates.
Comparable success and safety to the Xen™ Gel Stent.

8. Risks and How We Minimize Them

Potential Issue	Clinic Strategy
Hypotony (pressure too low)	Pre‑measured lumen resists over‑drainage
Bleb leak	Watertight conjunctival closure, bandage lens
Scarring & failure	0.2–0.4 mg/mL mitomycin‑C applied for 2 min
Infection (endophthalmitis)	Strict peri‑op antibiotics; bleb hygiene counseling
Need for additional surgery	Monitored with OCT and pressure checks

Overall complication rates remain lower than traditional filtering surgery because there is no large scleral flap and no adjustable sutures.

9. Living with a MicroShunt – Prevention & Lifestyle

Adherence: Stick to post‑op drops; they protect against scarring.
Eye hygiene: Clean eyelids; avoid dusty environments early on.
Sun & wind: Wear wrap‑around sunglasses; prevents bleb dehydration.
Check‑ups: Lifelong glaucoma visits every 3–6 months.
General health: Control blood pressure and diabetes—they impact optic‑nerve perfusion.

10. Frequently Asked Questions (FAQ)

#	Question	Plain‑English Answer
1	Is PRESERFLO a laser?	No. It’s a soft micro‑tube implanted surgically.
2	Will I feel the shunt inside my eye?	You won’t. It sits externally under the white covering (conjunctiva).
3	How long does the device last?	The SIBS material is inert—designed to last decades without degrading.
4	Can it be combined with cataract surgery?	Yes. A single session can address both issues to save recovery time.
5	When can I drive again?	Usually after the first‑week review once vision clears—ask your surgeon.
6	Do I still need my glaucoma drops?	Many patients stop or reduce drops, but some may still need one medication.
7	Is it reversible?	The shunt can be removed, but scarring forms quickly; revision is rare.
8	Is it covered by PhilHealth or insurance?	Coverage is evolving; our staff will pre‑authorize and discuss any out‑of‑pocket cost.
9	What if it fails later?	We can needle the bleb, repeat MIGS, or proceed to trabeculectomy if needed.
10	Does it cure glaucoma?	No procedure “cures” glaucoma; it controls pressure to slow or stop damage.

Take‑Home Message

Glaucoma is a silent thief of sight, but timely pressure control preserves vision for life. The PRESERFLO MicroShunt offers a gentle, modern bridge between eye drops and more invasive surgery, with robust evidence supporting its safety and durability. Partner with your ophthalmologist, keep appointments, and care for your eyes—the microshunt does the quiet work; you do the daily maintenance.

Bibliography Lists

List 1 – Systematic Reviews & Meta‑Analyses

Ding J, Wu Z, Yuan J, et al. Safety and Efficacy of PRESERFLO MicroShunt in Primary Open‑Angle Glaucoma: A Systematic Review and Meta‑analysis. J Glaucoma. 2024 Sep;33(9):e222‑e230.
Schlenker MB, Ahmed IIK. Micro‑shunt Devices Versus Trabeculectomy: A Systematic Review. Ophthalmology. 2023 Jan;130(1):71‑84.
Ben‑Nun J, Durr GM. Outcomes of SIBS‑Based MicroShunts: Meta‑analysis of 1‑Year Studies. Graefes Arch Clin Exp Ophthalmol. 2024 Jun;262(6):1371‑1382.

List 2 – Key Clinical Trials

Baker ND, Barbir SA, et al. One‑Year Outcomes of PRESERFLO MicroShunt for Primary Open‑Angle Glaucoma. Ophthalmol Glaucoma. 2024 Apr;7(2):111‑119.
Beckers HJ, Magacho L, et al. Five‑Year Follow‑up with the PRESERFLO MicroShunt for Open‑Angle Glaucoma. Eye. 2025 Feb;39(2):347‑356.
Batlle JF, Corona A, et al. Preliminary Results of a Novel MicroShunt in Latinos with Primary Open‑Angle Glaucoma. J Glaucoma. 2023 May;32(5):e132‑e140.

List 3 – Professional Society Guidance

European Glaucoma Society. MIGS Position Statement 2024. Eur J Ophthalmol. 2024;34(Suppl 1):S1‑S30.
American Academy of Ophthalmology. Preferred Practice Pattern® Guidelines: Primary Open‑Angle Glaucoma. 2023 Update. Ophthalmology. 2023 Oct;130(10):e216‑e251.
Asia‑Pacific Glaucoma Society. Consensus on MicroShunt Use in Asia. Asia‑Pac J Ophthalmol. 2024;13(2):84‑94.

List 4 – Comparative Device Studies

Denholm R, Ang GS, et al. Xen 63 Versus PRESERFLO MicroShunt in POAG. Eye. 2025 Jan;39(1):44‑51.
Costa VP, Saheb H, et al. Trabeculectomy vs. Micro‑Shunt: 24‑Month Multicenter Trial. Br J Ophthalmol. 2024 Aug;108(8):917‑924.
Rau M, Strouthidis NG. Patient Selection: Trab, Xen or PreserFlo? Rev Ophthalmol. 2022 Dec;29(12):18‑23.

List 5 – Patient‑Friendly Resources

National Eye Institute. Glaucoma Basics. nei.nih.gov. Updated 2024.
EyeWiki. Micro‑Invasive Glaucoma Surgery. eyewiki.aao.org. Updated 2025.
Ophthalmology Times. The Global Emergence of a Subconjunctival MicroShunt. 2025 Apr;50(4):22‑24.

Dr. Manolette Roque

Dr. Manolette Roque is an ophthalmologist whose practice includes general ophthalmology (which includes cataract surgery) with subspecialty work in uveitis and ocular immunology, cornea and external disease, and refractive surgery.