García-Bardera Javier, Garcia-Feijoo Julian, Morales-Fernández Laura, Heredia-Pastor Clara, Ponce-de-León Álvaro, García-Bermúdez Mireia, Pascual-Santiago Marco Antonio, Burgos-Blasco Bárbara, Martínez-de-la-Casa Jose María, Garcia-Sánchez Julián
Ophthalmology Unit, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain.
Ophthalmology Unit, Faculty of Medicine, Department of Ophthalmology and ORL, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.
Ophthalmol Glaucoma. 2025 May 2. doi: 10.1016/j.ogla.2025.04.011.
To evaluate the clinical outcomes of Preserflo MicroShunt (PMS) implantation with mitomycin C (MMC) in managing refractory childhood glaucoma previously treated with Ahmed glaucoma valve (AGV).
A single-arm retrospective cohort study.
Twenty-three eyes of 22 patients with refractory childhood glaucoma and a history of AGV implantation.
All patients underwent PMS implantation with intraoperative MMC (0.04% for 2.5 minutes). Primary endpoints included intraocular pressure (IOP) reduction, reduction in antiglaucomatous medications, and surgical success. "Complete success" was defined as achieving target IOP without medications; "qualified success" allowed for medications. Safety parameters included intraoperative and postoperative complications and the need for further interventions.
Intraocular pressure reduction, antiglaucomatous medication reduction, and surgical success rates.
Median follow-up was 23 months (interquartile range: 18-41). Mean baseline IOP was 27.0 ± 4.3 mmHg with 3.2 ± 0.5 medications. At 1 year, IOP decreased to 14.1 ± 4.4 mmHg (-47.0%) with 0.4 ± 1.0 medications and to 16.9 ± 3.6 mmHg (-40.2%) with 1.2 ± 1.5 medications at 2 years. Overall success rates for ≥20% IOP reduction were 91.3% at 1 year (69.9% complete success) and 72.7% at 2 years (45.5% complete success); for ≥30% reduction, they were 82.6% and 63.6%, respectively. During follow-up, 1 case of device extrusion was observed at 3 months, and another required surgical revision at 5 months.
Preserflo MicroShunt implantation with MMC offers a valuable surgical option for managing refractory childhood glaucoma after AGV. The procedure achieved substantial reductions in both IOP and medication burden. Larger studies with extended follow-up are recommended to confirm its long-term efficacy.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估在使用过艾哈迈德青光眼引流阀（AGV）治疗的难治性儿童青光眼中植入Preserflo微型分流器（PMS）并联合丝裂霉素C（MMC）的临床效果。
单臂回顾性队列研究。
22例有难治性儿童青光眼且有AGV植入史患者的23只眼。
所有患者均接受PMS植入并在术中使用MMC（0.04%，持续2.5分钟）。主要终点包括眼压（IOP）降低、抗青光眼药物使用减少以及手术成功。“完全成功”定义为无需使用药物即可达到目标眼压；“合格成功”允许使用药物。安全参数包括术中及术后并发症以及进一步干预的必要性。
眼压降低、抗青光眼药物使用减少以及手术成功率。
中位随访时间为23个月（四分位间距：18 - 41个月）。平均基线眼压为27.0±4.3 mmHg，使用3.2±0.5种药物。1年时，眼压降至14.1±4.4 mmHg（降低47.0%），使用0.4±1.0种药物；2年时，眼压降至16.9±3.6 mmHg（降低40.2%），使用1.2±1.5种药物。眼压降低≥20%的总体成功率在1年时为91.3%（完全成功为69.9%），在2年时为72.7%（完全成功为45.5%）；眼压降低≥30%的总体成功率分别为82.6%和63.6%。随访期间，3个月时观察到1例装置挤出，5个月时另1例需要手术翻修。
植入PMS并联合MMC为难治性儿童青光眼在AGV治疗后提供了一种有价值的手术选择。该手术使眼压和药物负担均大幅降低。建议进行更大规模且随访时间更长的研究以证实其长期疗效。
作者对本文讨论的任何材料均无专利或商业利益。
