Conclusions: Intraluminal stent-removal post-PGI surgery significantly reduces IOP with high success rates but carries the risk of hypotony and complications, e.g. suprachoroidal hemorrhage. Long-term management often requires the eventual addition of IOP-lowering therapy despite initial efficacy.

Background: To report outcomes after intraluminal stent removal following PAUL® Glaucoma Implant (PGI) surgery from a single-center cohort.

Methods: Retrospective review of patients undergoing intraluminal prolene removal following PGI surgery at the University Eye Hospital Bonn, Germany, from 04/2021 to 10/2023.

Results: 70 eyes of 68 patients were included. Qualified and complete success rates (95% CI) were 92.9% and 55.7% after one year and 88.6% (81.4-95.7%) and 50% (37.1-62.9%) at the last follow-up time point for IOP≤18 mmHg and 81.4% and 54.3 and 70% and 42.9% IOP≤15 mmHg, respectively. Mean IOP decreased from 23.93 mmHg to 12.07 mmHg after 12 months, 11.32 mmHg after 24 months and 10.41 mmHg after 36 months. The mean number of IOP-lowering eye drops was zero before and immediately after removal and increased to 1.57 (0-2) at 12 months, 1.15 (0-4) at 24 months and 1.12 (0-4) at 36 months. Postoperative complications occurred in 5 eyes (7.1%). Two eyes had suprachoroidal hemorrhage with one needing vitrectomy and one external tube ligation; one required PGI explantation for persistent hypotony.

Conclusions: Removal of the prolene stent following PGI surgery effectively lowers IOP in the short term, with a moderate increase in IOP and need for pressure-lowering therapy over time. However, it can also lead to adverse outcomes, such as hypotony and suprachoroidal hemorrhage, especially in patients with systemic risk factors or those undergoing early removal.