Clinical Outcomes of the PAUL® Glaucoma Implant for secondary glaucoma after vitreoretinal surgery

Background: 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 04/2021 to 05/2023. Results: 33 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 one year were 69.7% (54.5–84.8) and 97% (90.9-100) for Criterion A (IOP≤21mmHg), 66.7% (51.5-81.8) and 87.9% (51.5-81.8) for Criterion B (IOP≤18mmHg), 54.5% (39.4-72.7) and 72.7% (54.5-87.9%) for Criterion C (IOP≤15mmHg) and 24.2% (9.1-39.4) and 30.3% (15.2-48.4) for Criterion D (IOP≤12mmHg) respectively. Mean IOP decreased from 25.64 mmHg (14-49 mmHg) to 13.59 mmHg (8-20 mmHg) (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. Conclusions: 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.