Surgical Repair of the Extrusion of the Body of a PAUL Implant for Glaucoma

Abstract

The purpose of our article was to describe a simple but effective surgical technique performed on a patient with an extrusion of part of the body of a PAUL drainage implant for glaucoma. We present the case of a patient with refractory glaucoma and a history of multiple ocular interventions. A PAUL shunt was implanted and in the early postoperative period the patient presented extrusion of part of the implant body. An excessive scarring tissue at the lateral rectus muscle tendon hampered the placement of the lateral wing under the muscle; therefore, we decided to trim a part of it and suture the implant body to the sclera. The surgical technique that satisfactorily resolved the complication is described and shown in a video. This is the first time that such complication is described with the PAUL implant. We suggest that the intrinsic characteristics of the implant, mainly the dimensions, material, and thickness, made it possible for a potentially serious complication such as that described to be solved in a relatively simple and nontraumatic way for the eye.

Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma

“…The PAUL glaucoma implant (PGI) represents a recent addition to the array of GDDs, distinguished by its composition of silicone and unique structural features. Notably, the PGI sets itself apart by incorporating a smaller outer tube diameter of 467 μm and a reduced inner diameter of 127 μm compared to other available GDDs ( 7 ). Featuring an end plate with an expansive surface area measuring 342 mm 2 for aqueous absorption, the PGI occupies minimal space in the angle, while simultaneously demonstrating a lower redundant flow capacity in comparison with other valveless GDDs.…”

One-Year Outcomes of the PAUL Glaucoma Implant Compared With the Ahmed Glaucoma Valve for the Treatment of Silicone Oil Glaucoma

“…9 The PAUL glaucoma implant (PGI) is a newer shunt made of silicone and differs from other available GDDs by having both a smaller outer tube diameter of 467 μm and a smaller inner diameter of 127 μm (unlike the AGV). 10 The PGI has an endplate with a large surface area of 342 mm 2 for aqueous absorption that occupies lesser space in the angle. It also exhibits lower redundant flow capacity than other valveless GDDs and is large enough to provide extremely limited resistance to aqueous humor outflow.…”

“…The PGI is made of highly flexible silicone, which facilitates its mobilization and folding for placement under the rectus muscles with a small conjunctival opening, making it easy to use in the case of conjunctival scarring after vitreoretinal surgery. 10 Studies of AGV implantation for secondary glaucoma caused due to SO emulsification have been reported previously, but results of PGI surgery have not been reported. 11,12 The aim of this study was to evaluate the outcomes and complications of AGV and PGI surgery in patients with secondary glaucoma caused due to SO emulsification.…”

“…The AGV is a GDD that drains aqueous humor into a plate placed around the equator of the eye, used in patients with refractory glaucoma at high risk of trabeculectomy failure 9 . The PAUL glaucoma implant (PGI) is a newer shunt made of silicone and differs from other available GDDs by having both a smaller outer tube diameter of 467 μm and a smaller inner diameter of 127 μm (unlike the AGV) 10 . The PGI has an endplate with a large surface area of 342 mm 2 for aqueous absorption that occupies lesser space in the angle.…”

“…It also exhibits lower redundant flow capacity than other valveless GDDs and is large enough to provide extremely limited resistance to aqueous humor outflow. The PGI is made of highly flexible silicone, which facilitates its mobilization and folding for placement under the rectus muscles with a small conjunctival opening, making it easy to use in the case of conjunctival scarring after vitreoretinal surgery 10 . Studies of AGV implantation for secondary glaucoma caused due to SO emulsification have been reported previously, but results of PGI surgery have not been reported 11,12 .…”