• Shunsuke Nakakura, Yuki Nagata, Yasuko Fujisawa, and Yoshiaki Kiuchi.
• Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan.
• Medicine (Baltimore). 2024 Jul 5; 103 (27): e38847e38847.

IntroductionThe use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy.Patient ConcernsHowever, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery.DiagnosisExfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva.InterventionsWe performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge.OutcomesThe patient had better intraocular pressure control with positive cosmetic appearance using this technique.ConclusionThis technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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