Two-Year Clinical Outcomes of the PAUL Glaucoma Implant in White Patients With Refractory Glaucoma.

PRÉCIS: This prospectively collected case series of 56 eyes having PAUL glaucoma implant (PGI) surgery is the first to demonstrate its medium-term safety and effectiveness in what is essentially an exclusively Caucasian population.

BACKGROUND

To report 2-year outcomes from a single-center cohort undergoing PGI surgery.

METHODS

Prospectively collected data on patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021.

RESULTS

Of 53 patients, 56 eyes were included. Complete and qualified success rates (95% CI) were 52% (37-66) and 89% (80-96) for criterion A ( intraocular pressure [IOP]≤21 mm Hg), 48% (36-61) and 79% (67-88) for criterion B (IOP≤18 mm Hg), 45% (32-57) and 64% (52-77%) for criterion C (IOP≤15 mm Hg) and 27% (16-40) and 38% (25-50) for criterion D (IOP≤12 mm Hg), respectively. Mean IOP decreased from 25.43 mm Hg (7-48 mm Hg) to 11.25 mm Hg (3-24 mm Hg) (reduction of 50%) after 24 months with a reduction of IOP-lowering agents from 3.50 (1-5) to 0.46 (0-3). One eye needed an injection of viscoelastic due to significant hypotony with AC shallowing; 3 eyes received a Descemet membrane endothelial keratoplasty because of persistent corneal decompensation; 9 eyes developed tube exposure which required conjunctival revision with additional pericardial patch graft, with 5 of these eyes eventually needing tube explantation. An intraluminal prolene stent was removed in 24 eyes (42.9%) after a mean time period of 5.67 months (2-15 m). Mean IOP before removal was 21.4 mm Hg (12-40 mm Hg) and decreased to 11.15 mm Hg (6-20 mm Hg).

CONCLUSIONS

PGI surgery is an effective procedure for reducing IOP and pressure-lowering therapy. The use of an intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further noninvasive IOP lowering during the postoperative course.