Novel surgical approach to correct late-hypotony in PreserFlo MicroShunt

We report a novel surgical approach for managing late hypotony in PreserFlo MicroShunt blebs. Hypotony is a well-known complication of glaucoma filtering surgery, yet treatment options for late-onset cases remain limited. We describe two cases of uveitic glaucoma presenting with hypotony several months after PreserFlo implantation. Both patients were successfully treated with a bleb-modifying procedure. Under local anaesthesia, several interrupted 10-0 nylon sutures were placed in the bleb region to reduce its size and sectorise it, creating an iatrogenic ‘ring of steel’ that effectively corrected overfiltration. This technique appears to be a feasible and potentially effective option for managing late hypotony.