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

Eye volume 39, pages 931–937 (2025)Cite this article

Subjects

Abstract

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.

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Fig. 1: A Kaplan–Meier survival curve for eyes implanted with PAUL Glaucoma Implant over the duration of follow-up.
Fig. 2: Scatter plot comparing pre-operative and final visit Intraocular pressure.
Fig. 3: A series of graphs comparing the pre- and post-operative means (±95% confidence interval) for IOP and number of medications.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Ms Neeru A Vallabh for her supporting role in an earlier iteration of this project (10-month results).

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Authors and Affiliations

  1. Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK

    Jay Richardson, Filofteia Tacea, Jonathan Yu, Kenneth Yau, Cecilia Fenerty & Leon Au

  2. Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Cecilia Fenerty

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Contributions

JR—project design and planning, case finding, data collection, wrote and referenced all sections of the paper, statistical analysis, created figures and tables, interpreted results, submission to journal and responded to reviewers. FT—project design and planning, case finding, data collection, interpreted results, involved in writing and reviewing of the paper. KY, JY, CF—undertook surgical cases and reviewed paper prior to submission. LA—undertook surgical cases, initial project planning and reviewed paper prior to submission. All authors approved of the manuscript prior to submission.

Corresponding author

Correspondence to Jay Richardson.

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The authors declare no competing interests.

Ethics approval

As per the recommendations of the Health Research Authority (HRA) Research Ethics Committee (REC) guidance tool, no ethical review from an institutional review board or REC was required for this retrospective, observational study and the research was conducted in accordance with the principles of the Declaration of Helsinki.

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Richardson, J., Tacea, F., Yu, J. et al. The PAUL Glaucoma Implant in the management of uveitic glaucoma—3-year follow-up. Eye 39, 931–937 (2025). https://doi.org/10.1038/s41433-024-03527-x

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