PAUL implant- the latest in aqueous shunt device insertion surgery for advanced glaucoma

Home / Blog / PAUL implant- the latest in aqueous shunt device insertion surgery for advanced glaucoma

This blog has been contributed by the Moorfields Eye Hospital Dubai Glaucoma Team (Dr. Salman Waqar and Dr. Mohamed Sayed), who were the first in Dubai to insert the PAUL Implants in adults and children.

Glaucoma affects a significant percentage of the population worldwide, and the risk increases with age. The non-surgical treatment options available for most patients are medications to reduce pressure in the eye and laser trabeculoplasty, which targets the drainage angle of the eye.


However, for many patients with advanced glaucoma or complex secondary glaucoma, medications and laser treatments alone are not sufficient to control eye pressure and preserve vision.

In these circumstances, aqueous tube shunts (also known as aqueous shunt devices or glaucoma drainage devices) have a much broader range of efficacy even in patients with the highest risk.

The devices in common use are the Ahmed Valve and the Baerveldt Tube.

Now, at Moorfields Eye Hospitals UAE, we also offer surgery with the latest device known as the PAUL implant.

What is the PAUL implant?

The PAUL implant is the latest generation of aqueous shunt devices. It has been designed to optimize efficacy with a higher safety profile. It is composed of a soft tube that is inserted into the eye and drains away excess fluid thereby controlling the eye pressure. The diameter of this tube is less than half a millimeter and this prevents complications such as low pressure or corneal damage. The tube is connected to a thin and soft end-plate which is placed under the skin of the eye. This end-plate is very comfortable and causes no erosion or discomfort. It also does not degrade and lasts for the duration of the patient’s lifetime.

How does it work?

Glaucoma is most commonly associated with a build-up of fluid pressure inside the eye. This build-up of fluid pressure is caused by partial blockage of the natural drainage channel of the eye. This pressure can damage the optic nerve which carries images from the eye to the brain affecting your vision. This fluid produced inside your eye is called aqueous humour, which is different from your tears. The PAUL implant drains fluid from inside the eye to an end-plate on the outside, which is placed under a thin skin-like membrane covering the white of the eye called the conjunctiva. The fluid is then absorbed into the bloodstream.

What are the benefits?

The PAUL implant will lower your eye pressure and prevent further damage to the optic nerve caused by eye pressure (intraocular pressure). Its design ensures less chance of complications such as low IOP (hypotony), corneal damage and tube erosion, and a more predictable eye pressure control from the very first day after the surgery.

Are there any alternatives?

The closest alternatives to the PAUL implant are the traditional aqueous shunt implants such as the Baerveldt or Ahmed Implants. We aim to always individualise treatment options to your unique needs and will suggest the PAUL implant to you only if we feel it offers the best chance of controlling your eye pressure compared to other techniques.