Efficacy of PAUL Glaucoma Implant® for Refractory Uveitic Glaucoma

Evaluate the mid-term efficacy and safety of Paul Glaucoma Implant (PGI) in patients with refractory uveitic glaucoma (RUG).

Retrospective, single-center observational study. Patients aged 18 years or older with RUG and uncontrolled intraocular pressure (IOP) who underwent PGI implantation between November 2021 and January 2025 at a tertiary uveitis center were included. Surgical outcomes were evaluated at 6, 12, and 24 months postoperatively.Complete success was defined as IOP ≤ 18 mmHg without medications, qualified success as IOP ≤ 18 mmHg with medications, and failure as IOP > 18 mmHg, loss of light perception, or need for new glaucoma surgery. Secondary outcomes included postoperative complications, reinterventions, and functional outcomes.

25 eyes were included. Mean preoperative IOP was 25.5 ± 7.7 mmHg with 3.5 ± 1.1 medications. At 24 months, mean IOP decreased to 12.2 mmHg with a mean of 1.9 medications. Overall success was maintained in all eyes throughout follow-up. Complete success decreased from 28% at 6 months to 12.5% at 24 months, while qualified success increased from 72% to 87.5%. Visual field mean deviation remained stable (mean change -0.79 dB; p = 0.21). Postoperative complications included macular edema (20%), transient diplopia (20%), choroidal detachment (12%), hyphema (4%), and one case of endophthalmitis (4%) with full visual recovery. Surgical reintervention was required in 2 eyes (8%).

PGI provided sustained IOP reduction with a favorable safety profile in a RUG population. These findings support the PGI as a valuable surgical option in UG, although larger multicenter comparative studies are needed.