Two‐year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent

Purpose To evaluate 2‐year outcomes and complications following primary PAUL Glaucoma Implant (PGI) surgery using an external tube ligation technique without intraluminal stenting or antimetabolites. Methods This prospective study included 85 eyes of 85 consecutive patients with medically uncontrolled glaucoma undergoing primary glaucoma surgery. Fixed 24‐month outcomes were available for 80 eyes. All procedures were performed by a single surgeon using external tube ligation with two 6–0 polyglactin sutures. Success was defined as IOP between 6 and 21 mmHg with ≥20% reduction from medicated baseline, categorised as complete (no medications) or qualified (with medications). Preoperative and postoperative outcomes were compared using paired analyses. Kaplan–Meier analysis estimated cumulative success, and logistic regression evaluated factors associated with choroidal effusion. Results Mean IOP decreased from 33 ± 8 to 12 ± 4 mmHg at 24 months ( p < 0.001), corresponding to a 62% reduction. Medications decreased from 4.1 ± 0.9 to 1.0 ± 1.2 ( p < 0.001). At 24 months, complete and qualified success rates were 43% and 84%, respectively. Choroidal effusion occurred in 25 eyes (29%) and three required surgical drainage. More preoperative medications were associated with choroidal effusion after adjustment for treated preoperative IOP (OR 1.87, 95% CI: 1.03–3.39, p = 0.040). No endophthalmitis occurred. Exfoliation glaucoma showed higher complete success than other glaucoma types (54% vs. 31%, p = 0.045). Conclusions Primary PGI implantation using external ligation achieved substantial two‐year IOP and medication reduction. Early choroidal effusion was relatively common but usually self‐limiting.