Outcomes of the Paul Glaucoma Implant for Refractory Glaucoma in an Indonesian Population

PRECIS: The Paul Glaucoma Implant demonstrated favorable short- to mid-term outcomes in patients with refractory glaucoma in the Indonesian population. Low rates of postoperative hypotony following implantation were observed with the use of intraluminal 6/0 prolene stent. PURPOSE: To evaluate the efficacy and safety of the Paul Glaucoma Implant in managing refractory glaucoma in the Indonesian population. PATIENTS AND METHODS: This retrospective study reviewed patients who underwent implantation of the Paul Glaucoma Implant at the Kedoya and Menteng branches of the Jakarta Eye Center between September 2022 and January 2025. RESULTS: 121 implantations from 113 patients were included, with a median follow-up of 12.00 (12.00 - 24.00) months. Median intraocular pressure decreased from 35.00 (28.25 - 43.00) mmHg preoperatively to 15.00 (11.00 - 18.00) mmHg at one year and 15.00 (12.00 - 18.00) mmHg at two years. Median glaucoma medication use decreased from 3.00 (3.00 - 4.00) to 1.00 (0.00 - 1.00). Median best-corrected visual acuity improved from 0.30 (0.02 - 1.47) logarithm of the minimum angle of resolution preoperatively to 0.15 (0.00 - 1.00) at one year and 0.10 (0.00 - 0.60) at two years. Overall success rate of the Paul Glaucoma Implant was 98.08% at one year and 92.68% at two years. Four implantations (3.30%) failed, including two requiring explantation and two failing to achieve the target intraocular pressure reduction. Hypotony occurred in six eyes (4.96%), all self-resolving. An intraluminal 6/0 prolene stent was employed for implantations and removed in 81 eyes (66.94%), with a median removal time of 3.00 (2.00 - 4.00) weeks. CONCLUSION: The Paul Glaucoma Implant demonstrated favorable short- to mid-term outcomes, with substantial reductions in intraocular pressure and glaucoma medication use and a low rate of postoperative hypotony.