Results of Paul Glaucoma Implant Surgery in Ireland

The Paul Glaucoma Implant (PGI) is an effective and safe surgical intervention for the management of medically refractive glaucoma compared to its predecessors. That is the key conclusion of a multicentre retrospective analysis on the efficacy and safety of glaucoma drainage devices in Ireland.

Caoilfhinn Tan MD reported on the results of a study on PGI usage in Ireland from 2020 to 2024.

The usage of other drainage devices in the country, such as the Baerveldt glaucoma implant (BGI) and Ahmed Glaucoma Valve (AGV), was studied separately. These results were compared to the PGI usage study. The total study represents the largest analysis of glaucoma drainage devices in Ireland.

PGI study details

Dr Tan discussed the findings of a retrospective comparative chart review of the first 130 cases of glaucoma surgery using the PGI across three Irish tertiary centres—the Mater Misericordiae University Hospital and Royal Victoria Eye and Ear Hospital of Dublin and University Hospital Galway.

The patient cohort was complex, reflecting the typical glaucoma patient undergoing such surgery, with more than 71% having undergone previous eye surgery, primarily phacoemulsification. A smaller percentage had also undergone trabeculectomy, among other procedures.

The primary outcome of this study was surgical success based on predefined intraocular pressure (IOP) criteria (A ≤ 21, B ≤ 18, C ≤ 15, and D ≤ 12 mmHg). Secondary outcomes included reduction in IOP-lowering medications, best-corrected visual acuity maintenance, and visual field progression over an extended follow-up of five years (minimum follow-up of 12 months).

Positive findings

Across the three centres, a total of 130 cases of PGI surgery were reviewed, of which 27 were excluded and 103 included for analysis. Initial results demonstrated a marked reduction in mean IOP at 12 months (P < 0.0001) and 12±4 mmHg. The mean reduction in drops was significant (-2.06) and similar when compared with the other implant groups, Dr Tan reported. The complication rate was also low, and lowest in the PGI group compared to AGV and BGI, she said.

Dr Tan said the study findings showed PGI surgery for glaucoma had a high success rate, leading to a meaningful IOP reduction and drop in medication burden, which is particularly valuable in older patients.

Speaking to EuroTimes, Dr Tan said the patients who received the implants were quite a complex cohort, with refractory disease not adequately controlled by medication, a history of previous surgery, and a lack of suitability for a trabeculectomy. Further work will now take place on longer-term follow-up and subset analysis of patient selection.

Noting that glaucoma remains the leading cause of irreversible blindness worldwide, Dr Tan said this study is a valuable contribution to advancing the evidence base for complicated cases of glaucoma and optimum patient selection for drainage device surgery. The findings also highlight the need for national data sets on glaucoma implant usage.

The PGI is a non-valved glaucoma drainage device with an internal tube diameter of 0.127 mm and a flexible silicone endplate.

Dr Tan presented the PGI data at the Irish College of Ophthalmologists 2026 annual conference in Galway.

Caoilfhinn Tan MD serves in the Ophthalmology Department, Mater Misericordiae Hospital, Dublin, Ireland. caoilfhinntan@outlook.ie