Intraluminal stent removal from Paul glaucoma implants significantly reduces intraocular pressure in glaucoma patientsStent Removal Reduces Eye Pressure in Glaucoma Patients

American journal of ophthalmology Published October 4, 2026 Study authors: Lan Chiao-Hsin, Pao Shu-I, Tseng Hsiang-Lin, Yang Wen-Wu, Lu Da-Wen, Yen Wei-Ting PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that intraluminal stent removal from PGI significantly reduces IOP, especially in patients with high preremoval IOP.

This meta-analysis synthesizes data from 5 observational studies regarding the impact of intraluminal stent removal from the Paul glaucoma implant (PGI) on intraocular pressure (IOP). The analysis included 283 eyes to evaluate the efficacy and safety of this intervention.

The primary finding is a significant reduction in IOP following stent removal, with a mean difference of 9.09 (95% CI [-11.77, -6.41]). This reduction was more pronounced in the high-IOP subgroup (preremoval IOP >21 mm Hg), which showed a reduction of 11.82 mm Hg (95% CI [-10.14, -13.51]), compared to a reduction of 6.66 mm Hg (95% CI [-5.55, -7.77]) in the low-IOP subgroup (preremoval IOP <21 mm Hg).

Safety data indicate a low and highly consistent incidence of clinically hypotony. While the intervention appears effective and safe, the authors note that the underlying studies were observational, meaning a direct causal link cannot be strictly established. Clinical application should consider these limitations when managing glaucoma patients with PGI devices.

How this fits prior evidence

This meta-analysis addresses a gap in managing glaucoma patients with specific implant devices. While prior coverage noted that oxidative stress and reactive oxygen species mediate retinal ganglion cell death and optic nerve damage, this finding provides a specific surgical intervention for IOP reduction. It also addresses the management of postoperative glaucoma, which occurs in 25.6% of eyes following Boston Type 1 Keratoprosthesis implantation, by offering a specific technique for PGI patients.

Researchers looked at data from 283 eyes with a Paul glaucoma implant (PGI). They studied what happens to eye pressure when the internal stent is removed from the device. The study found that removing the stent led to a significant drop in intraocular pressure (IOP).

This reduction was especially notable in patients who started with high eye pressure. These patients saw a decrease of 11.82 mm Hg. Patients with lower initial pressure also saw a decrease, though it was less pronounced at 6.66 mm Hg.

While the procedure was found to be effective, there is a risk of hypotony, which is when eye pressure becomes too low. However, the study noted that cases of hypotony were low and consistent. Because this analysis was based on observational studies rather than a controlled trial, the results show a link but do not prove a direct cause. Patients should talk to their doctors about how these findings apply to their specific treatment plan.

What this means for you:

Removing a specific glaucoma implant stent can significantly lower eye pressure, especially in high-pressure cases.

Common questions

How much does removing the stent lower eye pressure?

The study found a significant reduction in eye pressure after removing the stent. For patients who started with high pressure (over 21 mm Hg), the pressure dropped by 11.82 mm Hg. For those with lower initial pressure (under 21 mm Hg), the pressure dropped by 6.66 mm Hg.

Is removing the stent safe for glaucoma patients?

The study reported that removing the stent is an effective and safe way to lower eye pressure. While there is a risk of hypotony (pressure that is too low), the study found that the incidence of this condition was low and highly consistent.

Who does this finding help the most?

This finding is particularly relevant for patients with a Paul glaucoma implant (PGI) who have high intraocular pressure before the stent is removed. These patients saw the most significant reduction in pressure during the study.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

PMID42250672

View Original Abstract ↓

PURPOSE: This study aims to systematically review and perform a single-arm meta-analysis to comprehensively evaluate the effect of removal of intraluminal stent from the Paul glaucoma implant (PGI) on intraocular pressure (IOP) changes and to summarize its long-term efficacy and safety. CLINICAL RELEVANCE: Glaucoma remains one of the leading global causes of irreversible vision loss, necessitating effective surgical management for refractory cases. Glaucoma drainage devices are critical for these complex forms, and intraluminal stent removal from the PGI serves as a key strategy to titrate aqueous outflow and optimize long-term IOP control. METHODS: A systematic review was conducted by searching EMBASE, Medline, and CENTRAL. The meta-analysis ultimately included 5 observational studies. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of the included studies. Continuous outcomes (eg, postremoval stent IOP reduction) were analyzed using the mean difference (MD) with 95% confidence intervals (CI); dichotomous outcomes (eg, hypotony incidence) were evaluated using pooled proportion with 95% CI. All meta-analyses employed a random-effects model. RESULTS: Our meta-analysis included 5 studies, involving a total of 283 eyes. The meta-analysis revealed that removal of the stent leads to a significant and immediate IOP reduction. The IOP reduction (immediate postremoval stent IOP minus preremoval stent IOP) was significant, with a pooled MD of -9.09 mm Hg IOP (MD = 9.09; 95% CI = [-11.77, -6.41]). In the preremoval stent high-IOP (>21 mm Hg) subgroup, the IOP reduction is -11.82 (95% CI = [-10.14, -13.51]). This reduction was significantly greater than the preremoval stent low-IOP (<21 mm Hg) subgroup, whose reduction is -6.66 mm Hg (95% CI = [-5.55, -7.77]). Regarding safety, the pooled proportion of clinically hypotony was low and highly consistent (I² = 0.00%) at only 0.03 (95% CI = [0.00, 0.15]). CONCLUSIONS: Intraluminal stent removal from the PGI is an effective and safe IOP-lowering intervention. Its IOP reduction effect is significantly more pronounced in patients with preremoval stent high IOP, providing crucial clinical guidance for managing persistently high IOP after PGI implantation.

Intraluminal stent removal from Paul glaucoma implants significantly reduces intraocular pressure in glaucoma patientsStent Removal Reduces Eye Pressure in Glaucoma Patients

How this fits prior evidence

Common questions

Study Details

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Intraluminal stent removal from Paul glaucoma implants significantly reduces intraocular pressure in glaucoma patientsStent Removal Reduces Eye Pressure in Glaucoma Patients

How this fits prior evidence

Common questions

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Study Details

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