PAUL <sup>®</sup> glaucoma implant – efficacy and safety: A systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background This systematic review and meta-analysis aim to evaluate the efficacy and safety of the PAUL ® Glaucoma Implant in reducing intraocular pressure and number of anti-glaucoma medication use in both adult and paediatric populations. Methods A systematic review was conducted following the PRISMA guidelines. The databases PubMed, Ovid-Embase and Scopus were searched to include studies published between January 2017 and September 2025. Studies were stratified by age and risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and ROBUST-RCT for randomized trials. Primary outcomes were intraocular pressures and number of glaucoma medications at each follow-up visits. Random effects meta-analyses were performed. Secondary outcome was complications. Results Twenty-four studies (twenty adults, four paediatric) comprising 836 eyes were included in our review and meta-analysis. Both adult and paediatric patients showed significant IOP reduction post-surgery, with a mean difference of 17.48 mmHg (95% CI: 14.59, 20.37) and 20.31 mmHg (95% CI: 7.80, 32.82) at 1 week, respectively, and sustained reductions at 12 months. The reduction in glaucoma medications was 79.2% for adults and 71.4% for children at 12 months. Subgroup analyses demonstrated greater IOP reduction in studies conducted in the Middle East. The uses of Mitomycin C did not significantly affect outcomes. Conclusion The PAUL ® glaucoma implant showed significant and sustained IOP reductions with reduced need for glaucoma medications. The PAUL ® glaucoma implant is a promising surgical option for glaucoma management in both adults and children. Further long-term prospective comparative studies are needed to assess long-term efficacies and allow direct comparisons with other glaucoma drainage devices.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.032 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".