BackgroundTo report one‐year outcomes from a single‐centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery.MethodsRetrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021.ResultsForty‐five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%–100%) and 73.3% (60%–86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%–93.3%) and 74.4% (51.1%–80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%–75.6%) and 46.7% (31.2%–62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%–40.0%) and 22.2% (11.1%–33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7–48 mmHg) to 12.0 mmHg (3–24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP‐lowering agents from 0.5 (0–3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2–12 m). Mean IOP before the removal was 21.9 mmHg (12–38 mmHg) and decreased to 11.3 mmHg (6–16 mmHg).ConclusionsPGI surgery is an effective procedure for reducing IOP and pressure‐lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course.

Précis: This retrospective study of 264 eyes having inferior quadrant trabectome surgery confirms its safety and relative effectiveness. Most patients however still require IOP-lowering agents, and a considerable proportion may need additional glaucoma surgery. Purpose: To report outcomes from a large single-center cohort of inferiorly-applied trabectome surgery. Patients and Methods: Retrospective review of patients undergoing trabectome surgery for chronic open angle glaucoma (COAG) at the University Eye Clinic Bonn, Germany, from 2012 to 2020. Results: Two hundred sixty-four eyes of 206 patients with COAG were included. The mean review period was 45.43 (range 12–101) months. One hundred five eyes (39.8%) underwent standalone surgery, of which 74 were pseudophakic and 31 phakic. The mean preoperative IOP was 17.58 mm Hg (range 12–50 mm Hg). One hundred five eyes (39.8%) developed a ‘failure event’ according to pre-defined criteria at a mean interval of 14.8 months postoperative. In absolute terms, 211 patients (79.9%) had a long-term IOP >14 mm Hg at 7.6 months, 174 patients (65.9%) >16 mm Hg at 10.6 months, 127 patients (48.1%) >18 mm Hg at 10.9 months, and 77 patients (29.2%) >21 mm Hg at 11.1 months. Over a five-year period, overall mean IOP remained stable at 13 mm Hg. The majority of patients were still on glaucoma drops (the mean number reduced from 2.9 to 2.7 agents). Subgroup analyses showed that a higher preoperative IOP was a positive predictor for failure, whereas combined surgery (with phaco) had better IOP outcomes (16.5 mm Hg vs. 19.3 mm Hg, respectively). Forty-one patients (15.5%) developed minor complications: 22 had high postoperative IOP within 3 months, 11 developed a self-resorbing hyphema, and 6 had fibrinous uveitis. Conclusions: Trabectome surgery is a safe and relatively effective procedure for lowering IOP, but most patients still need IOP-lowering agents, and a considerable proportion may need additional glaucoma surgery within a relatively short time. Inferior quadrant treatment may result in inferior IOP outcomes when compared with nasal quadrant surgery.

Background: The implantation of a collagen gel micro-stent (XEN45®) as a minimally invasive form of glaucoma surgery (MIGS) after a failed trabeculectomy (TE) may be an effective option with few risks. This study investigated the clinical outcome of XEN45® implantation after a failed TE, with follow-up data of up to 30 months. Materials and Methods: In this paper, we present a retrospective review of patients undergoing XEN45® implantation after a failed TE at the University Eye Hospital Bonn, Germany, from 2012 to 2020. Results: In total, 14 eyes from 14 patients were included. The mean follow-up time was 20.4 months. The mean time duration between the failed TE and XEN45® implantation was 110 months. The mean intraocular pressure (IOP) decreased from 17.93 mmHg to 12.08 mmHg after one year. This value increased again to 17.63 mmHg at 24 months and 16.00 mmHg at 30 months. The number of glaucoma medications decreased from 3.2 to 0.71, 2.0, and 2.71 at 12, 24, and 30 months, respectively. Conclusions: XEN45® stent implantation after a failed TE did not lead to an effective long-term decrease in IOP and glaucoma medications in many patients in our cohort. Nevertheless, there were cases without the development of a failure event and complications, and others in whom further, more invasive surgery was delayed. XEN45® implantation in some failed trabeculectomy cases may, therefore, be a good option, especially in older patients with multiple comorbidities.

Zusammenfassung Hintergrund Glaukom-Drainage-Implantate (GDI) stellen ein invasives Verfahren zur Behandlung beim Glaukom dar. Neben dem Baerveldt- und Ahmed-Glaukom-Implantat wurde das PAUL®-Glaukom-Implantat (PGI) als neues, innovatives Therapieverfahren entwickelt. Dieses unterscheidet sich v. a. hinsichtlich der geringeren Größe des Drainageröhrchens von den bisherigen Präparaten. Ziel der Arbeit Sechs-Monats-Ergebnisse des PGI wurden hinsichtlich Effektivität und Komplikationsrate analysiert. Methoden Eine Datenbank von Patienten, die mit dem PGI an der Universitäts-Augenklinik Bonn versorgt wurden, wurde zur Dokumentation aller wesentlichen Parameter erstellt und kontinuierlich anhand der Verlaufskontrollen vervollständigt. Die statistische Auswertung erfolgte mittels SPSS Statistics for Windows. Ergebnisse Insgesamt wurden in dieser Studie 53 Augen der ersten 51 konsekutiv mit dem PGI behandelten Patienten eingeschlossen. Der durchschnittliche Augeninnendruck lag präoperativ bei 26,62 mmHg (7–48 mmHg) und reduzierte sich auf 12,20 mmHg (3–22 mmHg) nach sechs Monaten. Die lokale drucksenkende Therapie konnte von 3,37 Wirkstoffen präoperativ auf 0,30 Wirkstoffe nach sechs Monaten gesenkt werden. Die Komplikationsrate war insgesamt gering, bei drei Patienten (5,7 %) kam es zu einer persistierenden Hypotonie. Bei 16 Patienten wurde im postoperativen Verlauf nach durchschnittlich 2,9 Monaten der intraluminale Prolenefaden entfernt. Danach kam es bei diesen Patienten zu einer Drucksenkung von 22,21 mmHg auf 11,07 mmHg. Schlussfolgerung Das PAUL®-Glaukom-Implantat stellt eine sichere Behandlungsmethode dar, die erfolgreich den Augeninnendruck auf ein niedriges Niveau senkt, die drucksenkende Lokaltherapie reduziert und mit einer geringen Komplikationsrate, besonders hinsichtlich postoperativer Hypotonien, einhergeht.