Comparison of Early Outcomes of PreserFlo MicroShunt, Ex-PRESS, and Trabeculectomy in Primary Open-angle Glaucoma

Precis: In primary open-angle glaucoma, PreserFlo MicroShunt achieved early intraocular pressure reduction comparable to Ex-PRESS and trabeculectomy, with fewer postoperative interventions. Purpose: To compare short-term outcomes of PreserFlo MicroShunt (PFM), Ex-PRESS (EXP), and trabeculectomy (TLE) in primary open-angle glaucoma. Methods: In this retrospective single-center study, 394 eyes undergoing PFM (78 eyes), EXP (193 eyes), or TLE (123 eyes) with ≥6 months follow-up were analyzed. Pairwise comparisons were performed using propensity score–based overlap weighting with doubly robust models. Surgical success was defined as ≥20% intraocular pressure (IOP) reduction with absolute IOP thresholds (≤21, ≤18, ≤15, ≤12 mmHg) without additional glaucoma surgery, laser treatment, or surgery for complications. Needling, laser suture lysis, and conjunctival resuturing were analyzed as postoperative interventions. Results: At 6 months, mean IOP was modestly lower after TLE compared with PFM, whereas no significant difference was observed between PFM and EXP. Qualified and complete success rates were comparable across procedures at all IOP thresholds. PFM was associated with fewer postoperative interventions than both EXP and TLE. Major complications were not increased with PFM, and visual acuity outcomes were similar among groups after adjustment. Conclusions: PFM demonstrated short-term outcomes broadly comparable to EXP and TLE, with a lower postoperative intervention burden. Longer-term prospective studies are needed.