The PAUL Glaucoma Implant in the management of uveitic glaucoma-3-year follow-up

BACKGROUND/OBJECTIVES: Evaluate the mid-term outcomes of the PAUL Glaucoma Implant (PGI) in the management of uveitic glaucoma. SUBJECTS/METHODS: This was a single-centre, multi-surgeon, retrospective analysis of 50 consecutive cases of PGI for uveitic glaucoma performed between April 2019 and August 2021. Primary outcomes include: complete and qualified success (IOP >= 5 mmHg to <= 21 mmHg with >= 20% IOP reduction) or failure (IOP exceeding the success criteria, additional glaucoma procedures, no perception of light vision). Secondary outcomes included: visual acuity, IOP, medications, complications and intraluminal stent removal. RESULTS: We included 50 eyes of 41 patients. Mean age was 45.8 +/- 19.8 years (range 6-81 years) in this heterogenous and complex cohort. Mean pre-op IOP was 30.6 +/- 9.8 mmHg on 3.9 +/- 0.9 medications. In total, 62% of patients were on acetazolamide, and 64% required systemic immunosuppression. At final follow-up (mean: 35.8 +/- 9.8 months, range 5-58 months), IOP and medications were significantly reduced (12.2 +/- 4.4 mmHg, requiring 1.1 +/- 1.3 medications, p < 0.0001). Resulting in 48% complete and 92% qualified success rates. Failure occurred in 8% of cases, 6% due to hypertension but only one case of prolonged hypotony (2%). CONCLUSIONS: To date, this study represents the first publication looking specifically at the efficacy and safety of the PGI in the management of complex uveitic glaucoma. With an average follow-up of 3 years, it shows high levels of complete and qualified success with few complications.