Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A simple surgical solution for the treatment of persistent postoperative hypotony after PRESERFLO MicroShunt implantation



PRESERFLO MicroShunt implantation is a relatively new and increasingly popular treatment for recalcitrant glaucoma. Though relatively uncommon, persistent or severe postoperative hypotony may occur and its treatment presents a significant challenge.


Interventional case series of the first 7 consecutive patients who underwent the insertion of a rip-cord suture to treat severe or persistent postoperative hypotony.


In 6 patients, the hypotony resolved and vision was restored. The 7th patient had suffered a severe suprachoroidal haemorrhage with a poor visual recovery and limited follow-up, so success was more difficult to assess.


Stenting the PRESERFLO MicroShunt with a rip-cord suture is a simple technique to correct persistent or severe postoperative hypotony.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Surgical steps for the insertion of an intraluminal rip-cord suture into a PRESERFLO MicroShunt (PMS).

Data availability

The dataset generated or analysed during the current study is available from the corresponding author on reasonable request.


  1. Pinchuk L, Riss I, Batlle JF, Kato YP, Martin JB, Arrieta E, et al. The development of a micro‐shunt made from poly(styrene‐ block ‐isobutylene‐ block ‐styrene) to treat glaucoma. J Biomed Mater Res. 2017;105:211–21.

    Article  CAS  Google Scholar 

  2. Baker ND, Barnebey HS, Moster MR, Stiles MC, Vold SD, Khatana AK, et al. Ab-Externo MicroShunt versus trabeculectomy in primary open-angle glaucoma. Ophthalmology. 2021;128:1710–21.

    Article  PubMed  Google Scholar 

  3. Scheres LMJ, Kujovic‐Aleksov S, Ramdas WD, Crom RMPC, Roelofs LCG, Berendschot TTJM, et al. XEN® Gel Stent compared to PRESERFLOTM MicroShunt implantation for primary open‐angle glaucoma: two‐year results. Acta Ophthalmol. 2021;99.

  4. Batlle J, Fantes F, Riss I, Pinchuk L, Alburquerque R, Kato Y, et al. Three-year follow-up of a novel aqueous humor MicroShunt. J Glaucoma. 2016;25:e58–65.

  5. Batlle JF, Corona A, Albuquerque R. Long-term results of the PRESERFLO® MicroShunt in patients with primary open-angle glaucoma from a single-center non-randomized study. J Glaucoma. 2020.

  6. Schlenker MB, Durr GM, Michaelov E, Ahmed IIK. Intermediate outcomes of a novel standalone Ab Externo SIBS microshunt with mitomycin C. Am J Ophthalmol. 2020;215:141–53.

    Article  CAS  PubMed  Google Scholar 

  7. Arrieta EA, Aly M, Parrish R, Dubovy S, Pinchuk L, Kato Y, et al. Clinicopathologic correlations of poly-(styrene-b-isobutylene-b-styrene) glaucoma drainage devices of different internal diameters in rabbits. Ophthalmic Surg Lasers Imaging. 2011;42:338–45.

    Article  PubMed  Google Scholar 

  8. Barberá MI, Hernández-Verdejo JL, Bragard J, Burguete J, Fernández LM, Rivero PT, et al. Evaluation of the ultrastructural and in vitro flow properties of the PRESERFLO MicroShunt. Trans Vis Sci Tech. 2021;10:26.

    Article  Google Scholar 

  9. Shin DY, Jung KI, Park HYL, Park CK. Risk factors for choroidal detachment after ahmed valve implantation in glaucoma patients. Am J Ophthalmol. 2020;211:105–13.

    Article  PubMed  Google Scholar 

  10. Iwasaki K, Kakimoto H, Arimura S, Takamura Y, Inatani M. Prospective cohort study of risk factors for choroidal detachment after trabeculectomy. Int Ophthalmol. 2020;40:1077–83.

    Article  PubMed  Google Scholar 

  11. Fannin LA, Schiffman JC, Budenz DL. Risk factors for hypotony maculopathy. Ophthalmology. 2003;110:1185–91.

    Article  PubMed  Google Scholar 

  12. Micheletti E, Riva I, Bruttini C, Quaranta L. A case of delayed-onset hemorrhagic choroidal detachment after PreserFlo Microshunt implantation in a glaucoma patient under anticoagulant therapy. J Glaucoma. 2020;29:e87–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations



All authors (SA, JHT, KB) have made substantial contributions to the conception and design of the work, the acquisition, analysis and interpretation of data or in the preparation of the manuscript.

Corresponding author

Correspondence to Soledad Aguilar-Munoa.

Ethics declarations

Competing interests

KB has received lecturing and consultancy fees from the Santen Pharmaceutical Company Ltd. SA-M receives salary support from a charitable donation by Martin-Baker Ltd. Y-HT declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aguilar-Munoa, S., Tham, YH. & Barton, K. A simple surgical solution for the treatment of persistent postoperative hypotony after PRESERFLO MicroShunt implantation. Eye (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links