Iridocorneal Endothelial (ICE) syndrome is often refractory to medical treatment and traditional surgical treatment has low success rates. We present a case of a lady in her mid-60s who presented to the eye emergency department with headache and blurred vision five months following an uncomplicated combined cataract surgery and pupilloplasty. The intraocular pressure (IOP) was found to be raised at 51mmHg in the left eye. ICE syndrome was suspected as there was left corectopia, angle closure due to peripheral anterior synechiae and corneal oedema. Initial medical management included topical IOP-lowering medications of Cosopt®(Dorzolamide/Timolol), Monopost® (Latanoprost), Iopidine® (Apraclonidine) eye drops and oral Acetazolamide tablets. Despite maximum medical treatment, the IOP remained inadequately controlled, requiring PreserFlo® Microshunt implantation. Her IOP remained stable postoperatively (10mmHg) at the last post-operative follow-up with no complication encountered. This case highlighted the effective long term management of elevated IOP secondary to ICE syndrome using PreserFlo® Microshunt when medical therapy fails.