Short-Term Outcomes of PreserFlo for Secondary Glaucoma After Combined DSAEK and Artificial Iris-IOL Implantation: A Case Report

Introduction: Secondary glaucoma following combined corneal transplantation and artificial iris-IOL complex implantation represents a significant therapeutic challenge. Reports of surgical management in such complex eyes remain limited. We report a case of successful PreserFlo MicroShunt implantation for the management of secondary glaucoma following combined Descemet stripping automated endothelial keratoplasty (DSAEK) and Reper artificial iris-IOL complex implantation. Case Presentation: A 54-year-old woman with a history of right eye corneal perforation resulting in aphakia underwent combined DSAEK and implantation of a Reper artificial iris-IOL complex (Reper-NN LTD, Nizhny Novgorod, Russia), in the right eye. Six-months after surgery, she developed secondary glaucoma with intraocular pressure (IOP) elevation to 30 mm Hg despite maximal tolerated medical therapy, accompanied by optic disc cupping, retinal nerve fiber layer thinning, and corresponding visual field defects. PreserFlo MicroShunt implantation was performed. Postoperatively, IOP decreased to 6 mm Hg with a well-functioning filtering bleb. The corneal graft remained clear throughout the 3-month follow-up. Conclusion: To our knowledge, this is the first report describing PreserFlo MicroShunt implantation for secondary glaucoma following combined Reper artificial iris-IOL implantation and endothelial keratoplasty. This case highlights the potential role of PreserFlo as a surgical option for IOP control in highly complex anterior segment eyes.