Minimally Invasive Glaucoma Surgery: iStent and Preserflo in the Treatment of Primary Open-Angle Glaucoma. A Review
Authors:
Richard Ulrych 1; Alexandr Stěpanov 1,2,3
Authors‘ workplace:
Oblastní nemocnice Mladá Boleslav, a. s.
1; 3. lékařská fakulta Univerzity Karlovy v Praze
2; Lékařská fakulta Slovenské zdravotnické univerzity v Bratislavě
3
Published in:
Čes. a slov. Oftal., 82, 2026, No. 2, p. 67-71
Category:
Review Article
doi:
https://doi.org/10.31348/2025/39
Overview
Glaucoma is a chronic, progressive and irreversible neuropathy of the optic nerve, characterized by morphological changes in the optic nerve papilla and defects in the visual field. Although the precise pathogenesis is not fully understood, the current concept of glaucoma development incorporates the deformation of the lamina cribrosa caused by elevated intraocular pressure, leading to axonal damage, subsequent apoptosis of retinal ganglion cells and loss of the nerve fiber layer. This review article discusses the current possibilities of using minimally invasive glaucoma surgery, specifically focusing on the micro-invasive implants iStent and Preserflo, their efficacy and safety in the surgical treatment of primary open-angle glaucoma.
Keywords:
primary open-angle glaucoma – minimally invasive glaucoma surgery – Preserflo MicroShunt – iStent
Sources
1. Weinreb RN, Leung CK, Crowston JG, et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016 Sep 22;2 : 16067. doi: 10.1038/ nrdp.2016.67
2. Salmon JF, Kanski JJ. Kanski‘s Clinical Ophthalmology: A Systematic Approach. 10th ed. London: Elsevier; 2023. p. 340
3. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004 May 22;363(9422):1711-1720. doi: 10.1016/S0140-6736(04)16257 - 0
4. Marshall LL, Hayslett RL, Stevens GA. Therapy for Open-Angle Glaucoma. Consult Pharm. 2018 Aug 1;33(8):432-445. doi: 10.4140/ TCP.n.2018.432
5. Výborný P. Glaukom. In: Rozsíval P, ed. Oční lékařství. Praha: Galén, Karolinum, 2006: p. 295-298
6. Gedde SJ, Singh K, Schiffman JC, Feuer WJ; Tube Versus Trabeculectomy Study Group. The Tube Versus Trabeculectomy Study: interpretation of results and application to clinical practice. Curr Opin Ophthalmol. 2012 Mar;23(2):118-126. doi: 10.1097/ ICU.0b013e32834ff2d1
7. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Tube versus Trabeculect omy Study Group. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) Study after five years of follow-up. Am J Ophthalmol. 2012 May;153(5):789-803. Epub 2012 Jan 15. doi: 10.1016/j.ajo.2011.10.026.
8. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLoS ONE 2017;12(8): e0183142. doi: 10.1371/journal. pone.0183142
9. Bloom P, Au L. Minimally Invasive Glaucoma Surgery (MIGS) Is a Poor Substitute for Trabeculectomy-The Great Debate. Ophthalmol Ther. 2018 Dec;7(2):203-210. Epub 2018 Jun 22. doi: 10.1007/s40123-018-0135-9
10. Mathew DJ, Buys YM. Minimally Invasive Glaucoma Surgery: A Critical Appraisal of the Literature. Annu Rev Vis Sci. 2020 Sep 15;6 : 47-89. doi: 10.1146/annurev-vision-121219-081737
11. Balas M, Mathew DJ. Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel). 2023 Aug 21;7(3):54. doi: 10.3390/vision7030054
12. Samuelson TW, Katz LJ, Wells JM, Duh YJ, Giamporcaro JE; US iStent Study Group. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology. 2011 Mar;118(3):459-467. Epub 2010 Sep 15. doi: 10.1016/j.ophtha.2010.07.007
13. Samuelson TW, Sarkisian SR Jr, Lubeck DM, et al. iStent inject Study Group. Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open - -Angle Glaucoma and Cataract: Two-Year Results. Ophthalmology. 2019 Jun;126(6):811-821. Epub 2019 Mar 14. doi: 10.1016/j. ophtha.2019.03.006
14. Hengerer FH, Auffarth GU, Conrad-Hengerer I. iStent inject Trabecular Micro-Bypass with or Without Cataract Surgery Yields Sustained 5-Year Glaucoma Control. Adv Ther. 2022 Mar;39(3):1417-1431. Epub 2022 Feb 3. doi: 10.1007/s12325-021-02039-4
15. Deneri S, Merté RL, Eter N, Brücher VC. Comparison of the iStent Inject® versus the iStent Inject® W-Both in Combination with Cataract Surgery-In Open-Angle Glaucoma. J Clin Med. 2023 Nov 23;12(23):7259. doi: 10.3390/jcm12237259
16. Sarkisian SR Jr, Grover DS, Gallardo MJ, et al. iStent infinite Study Group. Effectiveness and Safety of iStent Infinite Trabecular Micro - -Bypass for Uncontrolled Glaucoma. J Glaucoma. 2023 Jan 1;32(1):9 - 18. Epub 2022 Oct 20. doi: 10.1097/IJG.0000000000002141
17. Martínez-de-la-Casa JM, Saenz-Francés F, Morales-Fernandez L. et al. Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients. Sci Rep. 2021;11 : 15600. doi: 10.1038/s41598-021-95217-x
18. Fili S, Kontopoulou K, Vastardis I, Perdikakis G, Bechrakis N, Kohlhaas M. PreserFlo™ MicroShunt combined with phacoemulsification versus PreserFlo™ MicroShunt as a standalone procedure in patients with medically resistant openangle glaucoma. J Curr Ophthalmol. 2022;34 : 180-186.
19. Scheres, LMJ, Kujovic-Aleksov S, Winkens, B. et al. Five-year follow - -up with the PreserFlo MicroShunt for open-angle glaucoma. Eye. 2025;39 : 1540-1546. doi: 10.1038/s41433-025-03707-3
20. Bhayani, R, Martínez de la Casa JM, Figus M. et al. Short-term safety and efficacy of Preserflo™ Microshunt in glaucoma patients: a multicentre retrospective cohort study. Eye. 2023;37 : 644-649. doi: 10.1038/s41433-022-01995-7
21. Tanner A, Haddad F, Fajardo-Sanchez J, et al. One-year surgical outcomes of the PreserFlo MicroShunt in glaucoma: a multicentre analysis. Br J Ophthalmol. 2023 Aug;107(8):1104-1111. Epub 2022 Apr 1. doi: 10.1136/bjophthalmol-2021-320631
22. Mercieca K, Bhayani R, Martinez-de-la-Casa JM. et al. 3-Year Safety and Efficacy Results of PreserFlo™ Microshunt in Glaucoma Patients: A Multicentre European Cohort Study. AJO Int. 2024;1 : 100054.
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2026 Issue 2
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