PreserFlo MicroShunt Versus Trabeculectomy in Glaucoma Outcomes
Key Takeaways
- PreserFlo was associated with a smaller reduction in intraocular pressure than trabeculectomy, with a pooled mean difference of -2.73 mmHg.
- Complete and qualified surgical success appeared similar between the two procedures in the pooled data.
- PreserFlo was associated with lower odds of hypotony maculopathy and fewer overall postoperative complications.
This systematic review and meta-regression pooled comparative glaucoma studies of PreserFlo and trabeculectomy. The PRISMA-compliant analysis searched PubMed, Embase, and Scopus from inception through December 2025. It included 14 studies with 2,229 patients and follow-up ranging from 2 to 24 months. The open-access review was published in BMC Ophthalmology on 19 March 2026. The pooled analysis compared efficacy and safety across the included surgical studies.
Efficacy findings centered on less pressure reduction with PreserFlo than with trabeculectomy. The pooled mean difference for intraocular pressure reduction was -2.73 mmHg, with a 95% confidence interval from -3.84 to -1.61, and heterogeneity for pressure outcomes was moderate to high. Complete and qualified success rates were similar, with odds ratios of 0.95 and 0.97, respectively.
Safety outcomes favored PreserFlo on two pooled measures. The odds of hypotony maculopathy were lower with PreserFlo, with an odds ratio of 0.31 and a 95% confidence interval from 0.12 to 0.78. Overall postoperative complications were also less frequent, with an odds ratio of 0.48 and a 95% confidence interval from 0.38 to 0.60. PreserFlo was described as a less invasive alternative to trabeculectomy. On these measures, the complication profile favored PreserFlo.
Investigators used random-effects models for both continuous and dichotomous outcomes, along with leave-one-out sensitivity analyses and publication-bias assessments using funnel plots and Egger testing. Meta-regression examined prespecified covariates that included age, baseline intraocular pressure, medication burden, pseudophakia, prior surgery, and follow-up. Evidence of small-study effects was observed for selected outcomes. Across the pooled studies, surgical success was similar between procedures, while PreserFlo was associated with less intraocular pressure lowering and fewer complications.