First Reported Case Links PreserFlo MicroShunt Surgery to RPE Tear and Serous Retinal Detachment

To prevent further deterioration, surgeons performed scleral drainage and pars plana vitrectomy with sulfur hexafluoride (SF6) gas tamponade. The procedure successfully elevated IOP and led to the resolution of the detachment. Postoperatively, the patient’s IOP stabilized in the mid-teens with no recurrence of SRD, though postoperative angiography confirmed the presence of window defects consistent with RPE tears.

According to the authors, the case emphasizes that not only absolute postoperative hypotony but also a rapid and significant drop in IOP can disturb choroidal blood flow and compromise RPE function, especially in eyes with structural vulnerabilities. The findings suggest that eyes with exfoliation syndrome, long-term steroid exposure, or pre-existing choroidal circulatory compromise may be particularly susceptible to such complications.

Previous reports of SRD and RPE tears have been associated with conventional glaucoma filtration surgeries, but until now, none have been linked to PMS. The authors propose that the dramatic pressure change, combined with a fragile RPE due to chronic steroid use and atopic dermatitis, likely triggered the sequence of CD, RPE tear, and SRD in this case.

The report highlights the importance of individualized surgical planning and vigilant postoperative monitoring in glaucoma patients, especially when risk factors for RPE fragility exist. Early recognition of choroidal detachment and prompt IOP-elevating interventions may be critical in preventing vision-threatening outcomes.

"The study emphasizes that while PMS is generally safe and effective, clinicians should be aware of this rare but serious complication. Further research is needed to better understand the underlying mechanisms and to establish preventive strategies for high-risk patients undergoing minimally invasive glaucoma surgery," the authors concluded.

Reference:

Sadahide, A., Harada, Y., Sakaguchi, H. et al. Serous retinal detachment with retinal pigment epithelium tear after PreserFlo MicroShunt surgery: a case report. BMC Ophthalmol 25, 424 (2025). https://doi.org/10.1186/s12886-025-04259-6