Early surgical experience with the Paul Glaucoma Implant in complex glaucoma: A retrospective case series from Oman

Abstract:

This retrospective case series aimed to evaluate the feasibility, safety, and short-term outcomes of the Paul Glaucoma Implant (PGI) in patients with complex and refractory glaucoma at our tertiary center in Oman. It included five patients with complex glaucoma who failed medial therapy, treated at Sultan Qaboos University Hospital. All patients received the PGI implant with intraoperative mitomycin C and polypropylene suture stent for flow restriction. Intraocular pressure (IOP), visual outcomes, medication burden, and complications were monitored. Follow-up duration varied due to the staggered timing of surgeries. Median follow-up was 6 months (range: 2–23 months). IOP achieved surgical success criteria in four out of five eyes (mean preoperative IOP: 31.25 mmHg; mean postoperative IOP: 10.5 mmHg) with reduced medication burden. One patient with poor visual potential and chronic retinal detachment showed persistent hypotony. Another patient experienced transient numerical hypotony and hyphema, which was resolved with conservative treatment; otherwise, no major complications such as tube or plate exposure or corneal decompensation were observed. In conclusion, the PGI demonstrated promising early efficacy and safety in complex glaucoma cases in Oman. It appears to be a viable surgical option in cases where traditional modalities are limited.