Intraluminal stent removal after Paul glaucoma implant surgery: Intraocular pressure reduction and safety outcomes

PURPOSE: To evaluate the outcomes of intraluminal stent removal from the Paul glaucoma implant (PGI). METHODS: A retrospective observational study of all cases undergoing PGI stent removal from August 2022 to August 2025 at a single Danish tertiary centre. Primary endpoints were intraocular pressure (IOP) and IOP-lowering medications. Secondary endpoints were success rates and complications. RESULTS: A total of 114 consecutive PGI implantations with an intraluminal polypropylene 6-0 stent were performed from March 2022 to December 2024. A total of 88 eyes (77%) underwent stent removal at a mean of 113.5 ± 64.3 days after PGI implantation. Success at 6 months after stent removal, defined as 1) ≥20% IOP reduction with no increase in medications or 2) reduction of ≥1 number of IOP-lowering medications, was met in 77% (68 eyes) of the eyes. Washout of IOP-lowering medications prior to stent removal was performed in 68 eyes with an average IOP before and 1 week after stent removal of 24.5 ± 5.9 mmHg and 14.0 ± 7.4 mmHg, respectively. Clinically hypotony occurred in nine eyes after stent removal; three needed re-stenting. No other complications related to stent removal occurred. Stent removal <2 months after surgery was associated with a sixfold higher risk of clinical hypotony (p = 0.046). CONCLUSION: This study demonstrates that stent removal is an effective way to further reduce the IOP in the majority of patients after PGI surgery and that the risk of hypotony is low when removal is avoided in the early postoperative period.