PAUL Glaucoma Implant (PGI) surgery provides sustained, long-term reduction in intraocular pressure (IOP) and medication use in patients with refractory glaucoma, with effectiveness maintained over 3 years and the option for additional postoperative IOP lowering through intraluminal Prolene stent removal, according to a study.
The retrospective cohort included 60 eyes of 56 patients who underwent PGI implantation. Surgical success was evaluated using predefined IOP thresholds ranging from ≤21 mmHg to ≤12 mmHg.
Over 36 months, mean IOP declined by 54%, falling from 26.73 mmHg at baseline to 10.83 mmHg. There was also a reduction in IOP-lowering medications (3.38 to 0.57). Qualified success rates ranged from 88% under the least stringent IOP criterion to 30% under the strictest, while complete success rates ranged from 43% to 22%.
Postoperative complications included hypotony requiring intervention in 3 eyes, corneal decompensation requiring DMEK in 1 eye, and conjunctival revision for tube exposure in 7 eyes. Intraluminal Prolene stent removal was performed in nearly half of treated eyes, leading to an additional reduction in IOP.
Reference
Liegl C, Bourauel L, Aretz B, et al. Clinical outcomes of the PAUL® Glaucoma implant for refractory glaucoma: three-year results. Eye (Lond). 2025;doi: 10.1038/s41433-025-04131-3. Epub ahead of print. PMID: 41402597.
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