Two-year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent.

Cohort studyActa ophthalmologica· Jul 2026

Two-year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent.

Jyri-Pekka Koskinen, Juha Välimäki, Mohamed Geneid, Mika Harju

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GlaucomaCohort studyTreatmentQ1IF 3.0

Eye pressure was 62% lower two years after PAUL glaucoma implant surgery

Two-year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent.

Jyri-Pekka Koskinen … Mika Harju

Acta ophthalmologica · Jul 2026 · Q1 in Ophthalmology

Purpose

To evaluate 2-year outcomes and complications following primary PAUL Glaucoma Implant (PAUL Glaucoma Implant) surgery using an external tube ligation technique without intraluminal stenting or antimetabolites.

Methods

This prospective study included 85 eyes of 85 consecutive patients with medically uncontrolled glaucoma undergoing primary glaucoma surgery.

n = 85 eyes

Results

eye pressure checks showed much lower pressure two years after surgery

OR 1.87 (95% CI 1.03 to 3.39)

null 1

1.03

3.39

CI excludes the null - significant

More results

Medications decreased from 4.1 ± 0.9 to 1.0 ± 1.2 (p < 0.001).

At 24 months, complete and qualified success rates were 43% and 84%, respectively.

Choroidal effusion occurred in 25 eyes (29%) and three required surgical drainage.

More results

More preoperative medications were associated with choroidal effusion after adjustment for treated preoperative IOP (OR 1.87, 95% CI: 1.03-3.39, p = 0.040).

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Conclusion

Primary PAUL Glaucoma Implant implantation using external ligation achieved substantial two-year IOP and medication reduction. Early choroidal effusion was relatively common but usually self-limiting.

Two-year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent.

Two-year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent.

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