One tube for all: 1-year outcomes after transition to Paul glaucoma implant at a tertiary centre.
Studsgaard Anne, Nielsen Stine Elkjær, Telinius Niklas
AI Summary
The Paul Glaucoma Implant effectively lowered IOP in refractory glaucoma patients over 12 months, significantly reducing medication burden, suggesting its utility in challenging cases.
Abstract
Purpose
To evaluate the intraocular pressure (IOP) lowering effect and success rate of Paul glaucoma implant (PGI) in refractory glaucoma after changing practice pattern from Ahmed and Baerveldt tubes to PGI.
Methods
A prospective observational study of the first 50 consecutive PGI surgeries at a single Danish tertiary centre from January 2022 to October 2023. Primary endpoints were IOP and success rates after 12 months. Secondary endpoints were the use of IOP-lowering medications and complications. All cases had a risk of failure for traditional glaucoma surgery (neovascular glaucoma, oil-filled eye or uveitis).
Results
Preoperative IOP was 29.9 ± 8.6 mmHg and the mean number of topical IOP-lowering medications used was 3.4 ± 0.76 with 14 cases of systemic acetazolamide. Twelve months after surgery IOP was reduced to 11.4 ± 3.1 mmHg and complete success rate with (a) IOP≤21 mmHg was achieved in 43%, (b) IOP≤18 mmHg in 43%, (c) IOP≤15 mmHg in 41% and (d) IOP≤12 mmHg in 33%. Qualified success rate (on topical glaucoma medications) was achieved in (a) 96%, (b) 94%, (c) 86% and (d) 71% of the cases. The number of topical IOP-lowering medications was 0.9 ± 0.9 after surgery and 47% were medication free. Early (<3 months) and late (>3 months) complications were observed in 22% and 16% of patients respectively.
Conclusion
This study indicates that PGI provides a good IOP-lowering effect after 12 months in a population with risk factors for failure for traditional glaucoma surgery.
MeSH Terms
Shields Classification
Key Concepts5
The Paul glaucoma implant (PGI) reduced intraocular pressure (IOP) from a preoperative mean of 29.9 ± 8.6 mmHg to 11.4 ± 3.1 mmHg 12 months after surgery in patients with refractory glaucoma.
Complete success rate (IOP≤21 mmHg) for the Paul glaucoma implant (PGI) was achieved in 43% of cases 12 months after surgery in patients with refractory glaucoma.
Qualified success rate (IOP≤21 mmHg on topical glaucoma medications) for the Paul glaucoma implant (PGI) was achieved in 96% of cases 12 months after surgery in patients with refractory glaucoma.
The mean number of topical IOP-lowering medications used by patients with refractory glaucoma decreased from 3.4 ± 0.76 preoperatively to 0.9 ± 0.9 after Paul glaucoma implant (PGI) surgery, with 47% being medication-free at 12 months.
Early complications (<3 months) were observed in 22% of patients and late complications (>3 months) in 16% of patients after Paul glaucoma implant (PGI) surgery for refractory glaucoma.
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