Evidence map›Paper›PMID 40828215›Full record

ArticleActa ophthalmologica2026

Clinical outcomes of the PAUL glaucoma implant in primary open-angle and pseudoexfoliative glaucoma eyes after failed glaucoma surgeries.

Constance Liegl, Leonie Bourauel, Benjamin Aretz, Diana Samarghitan, Wolfgang Walz, Michael Petrak, Frank G Holz, Raffael Liegl, Karl Mercieca

Abstract read
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In one paragraph

Article in Acta ophthalmologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Constance LieglDepartment of Ophthalmology, University of Bonn, Bonn, Germany.
Leonie BourauelDepartment of Ophthalmology, University of Bonn, Bonn, Germany.ORCID https://orcid.org/0009-0001-8498-7396
Benjamin AretzInstitute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
Diana SamarghitanDepartment of Ophthalmology, University of Bonn, Bonn, Germany.
Wolfgang WalzDepartment of Ophthalmology, University of Bonn, Bonn, Germany.
Michael PetrakDepartment of Ophthalmology, University of Bonn, Bonn, Germany.
Frank G HolzDepartment of Ophthalmology, University of Bonn, Bonn, Germany.
Raffael LieglDepartment of Ophthalmology, University of Bonn, Bonn, Germany.ORCID https://orcid.org/0000-0002-6352-6259
Karl MerciecaDepartment of Ophthalmology, University of Bonn, Bonn, Germany.

Funding

Ernst und Berta Grimmke Stiftung 18/24
6 · The paper itself

Abstract

purposeThis study assesses the PAUL® glaucoma implant (PGI) in primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) after failed glaucoma surgery. Given PEXG's more aggressive nature, limited research exists on PGI outcomes in this subgroup. This study aims to compare PGI's efficacy and safety in both conditions.

methodsA retrospective cohort study including patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to January 2024. Patients were enrolled in a database at the time of surgery, with follow-up data collected at each visit. Success was defined according to four criteria, using intra-ocular pressure (IOP) thresholds of ≤21 mmHg (Criterion A), ≤18 mmHg (Criterion B), ≤15 mmHg (Criterion C) and ≤12 mmHg (Criterion D).

resultsForty-eight eyes of 48 patients were included. Qualified and complete success rates (95% CI) were 60.4% (45.8-72.9) and 93.8% (87.5-100) for Criterion A, 60.4% (45.8-72.9) and 85.4% (75-95.8) for Criterion B, 43.8% (29.2-56.3) and 58.3% (43.8-72.9) for Criterion C and 33.3% (20.8-47.9) and 35.4% (22.9-50) for Criterion D. Mean IOP decreased from 23.52 mmHg (7-45) to 11.65 mmHg (3-20 mmHg) with a mean reduction of 43.55% (0-82%) at 12 months, with a reduction in IOP-lowering agents from 3.13 (1-5) to 0.44 (0-3). Postoperative complications occurred in 33.3% of cases. Approximately 6.3% required additional glaucoma procedures, leading to surgical failure. Regarding primary outcomes, no significant differences were observed for qualified or complete success rates between POAG and PEXG. Both groups had similar preoperative IOP and experienced significant postoperative reduction, with no statistically significant differences in IOP, medication use, visual outcomes, complications, revision rates or surgical failure at 12 months.

conclusionsIn conclusion, the PGI demonstrated significant IOP reduction and decreased need for medication in both POAG and PEXG patients, with no major differences between the two groups at 12 months. The implant's overall safety and efficacy make it a viable surgical option for both conditions. Further studies are needed to assess long-term outcomes and refine patient selection criteria.

Indexed as

Exfoliation SyndromeGlaucoma Drainage ImplantsGlaucoma, Open-AngleIntraocular PressureVisual AcuityAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedProsthesis DesignReoperationRetrospective StudiesTreatment Outcomeglaucoma surgeryPAUL glaucoma implant outcomesPEXPOAG

Identifiers

PMID40828215
PMCPMC12888937

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.