PAUL® Glaucoma Implant versus Ahmed® Glaucoma Valve in Pediatric Glaucoma Following Congenital Cataract Surgery

Précis: Both PGI and AGV can be used to lower intraocular pressure with a good safety profile in children with glaucoma following cataract surgery. Purpose: To compare the effectiveness and safety of the Paul Glaucoma Implant (PGI) and the Ahmed Glaucoma Valve (AGV) in children with glaucoma following congenital cataract surgery (GFCS). Patients and Methods: This retrospective study included children aged 0–17 years with GFCS who underwent PGI implantation at a tertiary center between 2022 and 2024, with at least one year of follow-up. Outcomes were compared with a retrospective cohort treated with AGV. Primary outcomes were reduction in intraocular pressure (IOP) and number of antiglaucoma medications. Secondary outcomes included surgical success, defined as IOP ≤21 mmHg and ≥6 mmHg without failure criteria. Failure was defined as two consecutive IOP measurements outside the target after 3 months, need for oral acetazolamide, reoperation, implant explantation, or loss of light perception. Intraoperative and postoperative complications were recorded. Results: Fourteen eyes from 12 patients (7 per group) completed one-year follow-up. Mean IOP decreased significantly in both groups, from 26.7±5.2 to 14.4±3.0 mmHg in the AGV group and from 30.4±9.7 to 12.6±4.5 mmHg in the PGI group, with no significant intergroup difference. Median medication use decreased from 3 (IQR 0) to 0 (IQR 1) in the AGV group and from 4 (IQR 1) to 2 (IQR 2) in the PGI group. Complete or qualified success was achieved in 85.7% of AGV eyes and 100% of PGI eyes. No serious complications occurred. Conclusion: PGI and AGV showed comparable efficacy, safety, and surgical success in children with GFCS.