Clinical Outcomes of Intraluminal Stent Removal After PAUL Glaucoma Implant Surgery

Intraluminal stent-removal post-PGI surgery significantly reduces IOP with high success rates but carries the risk of hypotony and complications, for example, suprachoroidal hemorrhage. Long-term management often requires the eventual addition of IOP-lowering therapy despite initial efficacy.

To report outcomes after intraluminal stent removal following PAUL Glaucoma Implant (PGI) surgery from a single-center cohort.

Retrospective review of patients undergoing intraluminal prolene removal following PGI surgery at the University Eye Hospital, Bonn, Germany, from April 2021 to November 2023.

Seventy eyes of 68 patients were included. Qualified and complete success rates (95% CI) were 92.9% and 55.7% after 1 year and 88.6% (81.4% to 95.7%) and 50% (37.1% to 62.9%) at the last follow-up time point for IOP ≤18 mm Hg and 81.4% and 54.3% and 70% and 42.9% IOP ≤15 mm Hg, respectively. Mean IOP decreased from 23.93 to 12.07 mm Hg after 12 months, 11.32 mm Hg after 24 months, and 10.41 mm Hg after 36 months. The mean number of IOP-lowering eye drops was zero before and immediately after removal and increased to 1.57 (0 to 2) at 12 months, 1.15 (0 to 4) at 24 months, and 1.12 (0 to 4) at 36 months. Postoperative complications occurred in 5 eyes (7.1%). Two eyes had suprachoroidal hemorrhage, with one needing vitrectomy and one external tube ligation; one required PGI explantation for persistent hypotony.

Removal of the prolene stent following PGI surgery effectively lowers IOP in the short term, with a moderate increase in IOP and need for pressure-lowering therapy over time. However, it can also lead to adverse outcomes, such as hypotony and suprachoroidal hemorrhage, especially in patients with systemic risk factors or those undergoing early removal.