Successful Management Of Bilateral Secondary Glaucoma Following Cataract Surgery And 360 Scleral Buckle  Using The Paul Glaucoma Implant : A Case Report 

To describe the surgical management and clinical outcomes of a patient presenting with refractory bilateral secondary glaucoma following cataract extraction then scleral buckle, successfully treated with sequential bilateral Paul Glaucoma Implant (PGI) surgery.

Frimley Park Hospital NHS Foundation Trust , Frimley , Surrey

A 26-year-old male surgery registrar was referred for refractory bilateral glaucoma. He had high myopia, ocular hypertension, and bilateral visually significant cataracts. At presentation, best-corrected visual acuity was 1/60 in the right eye (RE) and 6/33 in the left eye (LE), with intraocular pressures (IOP) of 29 mmHg and 32 mmHg. Topical latanoprost was initiated. After uncomplicated right phacoemulsification, he developed proliferative vitreoretinopathy with exudative retinal detachment, requiring scleral band placement.The left eye subsequently developed retinal detachment and underwent scleral band surgery followed by combined cataract extraction and pars plana vitrectomy with gas tamponade. Postoperatively, IOP became markedly unstable, peaking at 60 mmHg (RE) and 50 mmHg (LE) despite maximal topical therapy and oral acetazolamide. Bilateral cyclodiode laser was performed but failed to achieve sustained control. Sequential bilateral implantation of the Paul Glaucoma Implant in the superonasal quadrant with anterior chamber tube insertion and 6-0 Prolene ripcord resulted in IOP stabilization at 12/15 mmHg at two months and 10 mmHg bilaterally at four months and 12 mm Hg at 12 months. Medications were reduced to preservative-free Cosopt alone. No device-related complications occurred. The retina remained attached. Right cystoid macular edema developed and resolved with topical NSAIDs.

The Paul Glaucoma Implant is an effective surgical option for managing complex, bilateral secondary glaucoma following vitreoretinal and cataract surgery. Its small-calibre tube design effectively regulates IOP while minimising the risk of postoperative hypotony, making it a viable alternative in refractory cases where traditional filtering surgery may have a high risk of failure.