Bilateral Preserflo MicroShunt Implantation after Descemet's Stripping Automated Endothelial Keratoplasty: A Case Report

Aim and background: To describe a case of Preserflo MicroShunt implantation in both eyes of a patient with intraocular pressure (IOP) rise after receiving bilateral Descemet’s stripping automated endothelial keratoplasty (DSAEK), with poor IOP control by medical treatment alone. Case description: A female patient, previously diagnosed with primary open-angle glaucoma (POAG) and Fuchs’ corneal dystrophy in both eyes, developed bilateral bullous keratopathy in late 2021. The patient underwent combined DSAEK and cataract surgery in her right eye (RE) in December 2021 and in April 2022 in her left eye (LE). After the surgical procedures, we observed an IOP rise not controlled by medical treatment. Bilateral Preserflo MicroShunt implantation was chosen as the surgical option to reduce the IOP increase and was performed in June 2022 in the LE and in July 2022 in the RE. The Preserflo MicroShunt implantation was successful in reducing the IOP in both eyes after bilateral DSAEK without the need for any additional hypotonic medical treatment. We observed good positioning of the device and the maintenance of corneal graft transparency and adhesion in both eyes after a 6-month follow-up from the most recent procedure. Conclusion: Preserflo MicroShunt has the potential to be a safe and effective technique in cases of IOP increase after endothelial keratoplasty. Further investigations with larger patient samples are required to validate our findings. Clinical significance: IOP elevation after corneal transplantation can pose a challenge in the postoperative period and may lead to the need for glaucoma surgery. Our report on a case of bilateral Preserflo implantation after DSAEK highlights the potential benefits of this relatively new glaucoma surgical technique in the management of these patients.