What is the Paul glaucoma implant?
The Paul glaucoma implant is a type of aqueous shunt, sometimes called a tube or drainage implant. It is a small, flexible silicone device made up of a thin tube attached to a soft plate. During surgery, the plate is secured to the white of the eye (the sclera) beneath the outer membrane and eyelid tissues, so it is not visible in day-to-day life. The tube is then carefully inserted into the eye so that fluid (aqueous humour) can drain from inside the eye to a reservoir formed around the plate, where it is absorbed by the body.
By creating an alternative drainage pathway, the implant is designed to reduce intraocular pressure. This is important because raised eye pressure is the main modifiable risk factor for glaucoma progression, as reflected in NICE guidance on glaucoma diagnosis and management.
Who may benefit from a Paul glaucoma implant?
Glaucoma drainage surgery is usually considered when less invasive options are no longer sufficient. A Paul glaucoma implant may be suitable if:
- your eye pressure remains higher than your target level despite maximum tolerated eye drops
- your visual field or optic nerve scans show ongoing deterioration
- a previous trabeculectomy or minimally invasive glaucoma surgery has not worked as hoped
- you have a form of glaucoma in which trabeculectomy carries a higher chance of failure, such as neovascular, uveitic or post-surgical glaucoma
- you have difficulty tolerating or using drops reliably
- you have very advanced glaucoma where a low, stable pressure is needed to protect remaining sight
Not everyone with glaucoma needs tube surgery. Many people are managed successfully with drops, laser treatment such as selective laser trabeculoplasty, or minimally invasive glaucoma surgery combined with cataract surgery. Your clinician will advise you based on your assessment, your pressure targets and the amount of optic nerve damage already present.
Conditions and problems that may be treated
- primary open-angle glaucoma that continues to progress
- angle-closure glaucoma, including after acute angle closure
- secondary glaucoma related to inflammation (uveitis), trauma, or previous eye surgery
- neovascular glaucoma associated with diabetes or retinal vascular disease
- glaucoma following corneal transplantation or vitreoretinal surgery
- ocular hypertension with very high pressures unresponsive to other treatment
- intolerance or allergy to multiple glaucoma medications
Potential benefits
Glaucoma surgery aims to protect the sight you have rather than to restore vision that has already been lost. Where surgery is successful, it may:
- substantially lower intraocular pressure and help stabilise it
- reduce or, in some cases, remove the need for glaucoma eye drops
- help slow further optic nerve damage and visual field loss
- improve comfort for those experiencing drop-related irritation or allergy
- support long-term management in complex glaucoma where other options have failed
Results vary between patients, and some people still require drops or additional treatment afterwards.
Consultation and assessment
A thorough assessment is essential before any decision is made. During your consultation with Ms Diana Urbaneja you can expect:
- a discussion of your symptoms, glaucoma history, previous treatments and general health
- a full eye examination, including vision testing, pressure measurement and examination of the optic nerve and drainage angle
- diagnostic imaging where appropriate, such as visual field testing and OCT scans of the optic nerve, and anterior segment imaging in angle-closure cases
- a review of your target pressure and how quickly your glaucoma has been changing
- a clear explanation of the options, including drops, laser, MIGS, trabeculectomy and drainage implant surgery
- an honest discussion of the risks, benefits and alternatives, so you can give informed consent
How the surgery is performed
Paul glaucoma implant surgery is usually carried out as a day-case procedure in a hospital eye theatre. It is most often performed under local anaesthetic, with sedation if needed, although general anaesthetic may be recommended in some circumstances.
In broad terms, the surgeon lifts the surface membrane of the eye, positions and secures the plate on the sclera behind the eye muscles, covers the tube with a protective patch of donor tissue, and inserts the tube into the eye through a small opening. The tube may be temporarily tied off or partially occluded so that pressure does not fall too low in the early healing period; this releases or is opened later, often several weeks after surgery. The procedure typically takes around an hour, and you will go home the same day with antibiotic and anti-inflammatory drops.
Recovery and aftercare
Most people notice blurred vision, mild soreness, redness and watering for the first few weeks. Vision often fluctuates while the eye settles and may take several weeks to months to stabilise.
- use your prescribed drops exactly as instructed, and attend all follow-up appointments
- expect frequent reviews in the first two to three months, as pressure needs close monitoring
- avoid rubbing the eye, swimming and heavy lifting until advised otherwise
- many people return to light activities and desk-based work within one to two weeks, depending on healing
- you may be advised to stop, restart or adjust glaucoma drops during recovery
Seek urgent advice if you develop increasing pain, a sudden drop in vision, marked redness or discharge, as these may indicate a complication requiring prompt attention.
01
Consultation
Assessment for complex glaucoma
02
Surgery
Implant surgery, day case
03
Aftercare
Regular monitoring
Guide Price
Price TBC
Priced according to your individual case. See the pricing page for all options.
At a glance
Anaesthetic
Local
Procedure time
~45-60 min
Stay
Day case
Recovery
A few weeks
Follow-up
Close monitoring