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.