July 2019


MIGS Update
PreserFlo: The device formerly known as the InnFocus Microshunt

Implanted via an ab externo technique similar to the way Dr. Do and Dr. Panarelli are currently implanting the XEN 45, they expect the PreserFlo will help surgeons “bridge the large gap between our trabecular bypass/ablative procedures and traditional glaucoma surgeries,” they said. “In a sense, it functions similarly to a trabeculectomy in that it creates a subconjunctival bleb, but the procedure is considerably less invasive and requires much less postoperative intervention.”
Dr. Kim posits how his practice might look with these new devices in his surgical toolbox. “I think for those patients for whom I am seeking profound IOP lowering that Schlemm’s canal-based MIGS cannot deliver, and who have healthy and unscarred conjunctiva, open angles, no history of uveitis/inflammation, and no history of NVG, I will likely use XEN-ex (ab externo transconjunctival XEN implantation) as the first line surgical treatment,” he said. “If this fails and bleb needling for it fails, I will turn to the InnFocus Microshunt (if and when it gets FDA approved and becomes commercially available) placed in an adjacent superior quadrant. If this fails, I would then likely turn to glaucoma drainage implants such as a Baerveldt Glaucoma Implant [Johnson & Johnson Vision]. XEN-ex has the advantage of being extremely vast, not requiring incisions, and offering immediate visual recovery. The InnFocus has the advantage of having a larger diameter lumen less likely to get clogged by pigment and debris but would have the disadvantage of requiring extensive conjunctival dissection and closure. I think the InnFocus would replace my current open XEN with tenonectomy technique, so I would probably use it in place of XEN-ex in cases at higher risk for failure (young, deeply pigmented, inflamed conjunctiva, etc).”
The devices differ in terms of material and size. “The InnFocus Microshunt is 8.5 mm in length with a luminal diameter of 70 micrometers and is composed of SIBS (styrene-block-isobutylene-block-styrene) material,” Dr. Do and Dr. Panarelli said. “By contrast, the XEN gel stent is 6 mm in length with a 45-micrometer lumen and is made of porcine gelatin. These subtle differences may lead to slight differences in outcomes with each device, but a comparison among the two new microstents has not been performed yet.”

PreserFlo: The device formerly known as the InnFocus Microshunt PreserFlo: The device formerly known as the InnFocus Microshunt
Ophthalmology News - EyeWorld Magazine
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