Clinical Outcomes of the PAUL® Glaucoma Implant for Secondary Glaucoma after Vitreoretinal Surgery.

INTRODUCTION

The aim of this study was to report clinical outcomes from a single-center cohort undergoing PAUL® glaucoma implant (PGI) surgery for secondary glaucoma after vitreoretinal surgery (VR).

METHODS

Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April/2021 to May/2023 was conducted.

RESULTS

Thirty-three eyes of 33 patients were included. Mean number of preoperative VR surgeries was 2 (1-4), the majority following retinal detachment (23 eyes, 69.7%). 18 eyes had previous silicone oil tamponade (54.4%). Complete (without drops) and qualified (with or without drops) success rates (95% CI) after 1 year were 69.7% (54.5-84.8) and 97% (90.9-100) for criterion A (IOP ≤21 mm Hg), 66.7% (51.5-81.8) and 87.9% (51.5-81.8) for criterion B (IOP ≤18 mm Hg), 54.5% (39.4-72.7) and 72.7% (54.5-87.9%) for criterion C (IOP ≤15 mm Hg), and 24.2% (9.1-39.4) and 30.3% (15.2-48.4) for criterion D (IOP ≤12 mm Hg), respectively. Mean IOP decreased from 25.64 mm Hg (14-49 mm Hg) to 13.59 mm Hg (8-20 mm Hg) (reduction of 41.1%) after 12 months with a reduction of IOP-lowering agents from 3.21 (1-5) to 0.38 (0-3). Seven eyes (21.2%) developed postoperative complications, most of which eventually resolved. Two eyes had a tube flushing because of high postoperative IOP with silicone oil obstruction. Postoperative non-glaucoma-related procedures were performed in 10 eyes (24.4%). None of these led to high IOP or further complications in the postoperative phase.

CONCLUSION

PGI surgery is an effective procedure for reducing both IOP and topical therapy in patients with uncontrolled secondary glaucoma following vitreoretinal surgery. Non-glaucoma-related procedures can be safely performed after PGI implantation with good IOP control.