Clinical Outcomes of Combined Pars Plana Vitrectomy and PAUL Glaucoma Implant

In complex cases of secondary glaucoma following vitreoretinal surgery (VR) where patients require both intraocular pressure (IOP) control and treatment of coexisting vitreoretinal (VR) pathology, a combined surgical approach with VR surgery and glaucoma drainage devices (GDD) may be necessary. However, there is limited literature on the outcomes of PAUL® Glaucoma Implant (PGI) implantation in conjunction with pars plana vitrectomy (PPV). The goal of this study was to evaluate the clinical outcomes and safety of simultaneous combined PGI implantation and pars plana vitrectomy (ppV) in patients with complex or refractory glaucoma requiring concurrent VR surgery. This monocentric retrospective case series included six eyes of six patients who underwent combined PGI implantation and PPV at the University Eye Hospital Bonn, Germany, between October 2022 and March 2024. Pre- and postoperative data on IOP, best-corrected visual acuity (BCVA), number of glaucoma medications, complications, and reinterventions were collected over a minimum follow-up period of 12 months. Mean preoperative IOP was 34.0 mmHg (31-38 mmHg), which decreased to 12.01 mmHg (8 – 14 mmHg) after 12 months. The mean number of IOP-lowering medications was reduced from 2.83 (1-5) to 1.8 (0-2) without requiring systemic acetazolamide. BCVA improved from a mean of 1.80 logMAR to 1.15 logMAR. Complications included tube migration with exposure requiring explantation, silicone oil-related tube occlusion, and transient hyphema. Combined PGI implantation and PPV provided effective IOP control with an acceptable safety profile. These findings suggest that this combined approach represents a viable surgical option for challenging glaucoma cases requiring simultaneous vitreoretinal intervention.