One-year outcomes of the PAUL glaucoma implant versus ahmed glaucoma valve for the treatment of glaucoma following cataract surgery

PURPOSE: This study evaluated and compared the 1-year outcomes of the PAUL Glaucoma Implant (PGI) and the Ahmed Glaucoma Valve (AGV) in the management of aphakic glaucoma. METHODS: A retrospective study was conducted on 30 eyes of 28 patients with aphakic glaucoma who underwent implantation of PGI (n = 10) or AGV (n = 20). Primary outcomes included surgical failure and success (complete or qualified). Secondary outcomes included intraocular pressure (IOP) reduction, best-corrected visual acuity (BCVA), medication use, and postoperative complications. Kaplan-Meier survival analysis was applied, with failure defined as IOP > 21 mmHg on two consecutive visits, implant removal, additional glaucoma surgery, or vision loss. RESULTS: At 12 months, surgical success was achieved in 90% of PGI eyes and 75% of AGV eyes (p = 0.766). Complete success occurred in 30% (PGI) and 25% (AGV), while failure occurred in one PGI eye and five AGV eyes. Kaplan-Meier analysis revealed comparable cumulative success rates (p = 0.475). Mean IOP at 12 months was similar between groups (16.0 vs. 16.4 mmHg; p = 0.854), with significant reductions from baseline (PGI: p = 0.002; AGV: p < 0.001). Both groups showed reduced medication burden (p < 0.001), with PGI requiring fewer agents at 1-2 months (p = 0.024). BCVA remained stable. One complication was recorded, a case of choroidal haemorrhage in the AGV group; the hypotony episode was not classified as a complication as it resolved without visual loss or further surgical intervention.). CONCLUSIONS: PGI and AGV both effectively managed aphakic glaucoma. PGI demonstrated a trend toward higher success rates and fewer complications; however, these differences were not statistically significant. These findings suggest that PGI may be a favourable alternative, although larger prospective studies are needed to confirm this potential advantage.