Successful management with Paul® Glaucoma Drainage Implant after complicated bleb needling with uveal prolapse into the bleb ten years after trabeculectomy

This case highlights a rare occasion of scleral thinning leading to perforation with uveal prolapse after needling, 10 years post-trabeculectomy. Likely causes include the use of antimetabolites, cyclodestructive procedures, and chronic conjunctival inflammation from eyedrops. Although needling is typically low-risk, it can lead to complications similar to trabeculectomy. Preoperative screening for scleral thinning using slit lamp and anterior segment OCT is recommended for high-risk patients. The presented two-stage treatment strategy proved successful in managing this complex case.