The Paul Glaucoma Implant versus the Ahmed and Baerveldt Glaucoma Implants: A Systematic Review and Bayesian Network Meta-Analysis.
9 affiliations
- 1Faculty of Medicine, Port Said University, Port Said, Egypt.
- 2Department of Clinical Research, Aswan Heart Center, Magdi Yaqoup Foundation, Aswan, Egypt.
- 3Faculty of Medicine, Al-Balqa' Applied University, Salt, Jordan.
- 4Faculty of Health Sciences, Obafemi Awolowo University, Ile-Ife, 22005, Nigeria.
- 5Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- 6Faculty of Medicine, Cairo University, Cairo, Egypt.
- 7Division of Ophthalmology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
- 8Department of Ophthalmology, Faculty of Medicine, McMaster University, Hamilton, Canada.
- 9Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
Abstract
Purpose
To compare the efficacy and safety of the Paul Glaucoma Implant (PGI) with those of the two established glaucoma drainage devices, the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI).Methods
PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, ScienceDirect and Google Scholar were searched. Eligible studies were randomised or comparative observational studies reporting outcomes in patients who received the PGI alongside a concurrent AGV or BGI comparator. The primary outcomes were intraocular pressure (IOP) reduction, surgical success rate, and reduction in glaucoma medications. A Bayesian network meta-analysis was performed, with treatment ranking summarized by surface under the cumulative ranking curve (SUCRA). Quality assessment and evidence certainty was performed using the Cochrane Risk of Bias tool and GRADE framework respectively.Results
Five comparative studies (238 patients) were included. Relative to the AGV, the PGI was associated with a mean difference in IOP at 12 months of -3.344 (95% CrI -7.743 to 1.058) mmHg, and relative to the BGI of 4.387 (95% CrI -0.288 to 9.074) mmHg. Corresponding differences in medication number at 12 months were]-0.186 (95% CrI -0.858 to 0.545) and 0.444 (95% CrI -0.358 to 1.272). Credible intervals crossed the null for 29 of the 30 primary contrasts. Ranking probabilities favoured the AGV for IOP reduction from 3 to 12 months (SUCRA 0.885 to 0.976) and the PGI for early medication reduction (SUCRA 0.769 at 1 month), but these rankings were derived from imprecise estimates. Safety estimates were based on small numbers of events and several were unstable. Certainty of evidence was low to very low for most comparisons.Conclusion
Within the limits of a small and predominantly non-randomised evidence base, the PGI achieved intraocular pressure and medication reduction broadly comparable to those of the AGV and BGI over the first postoperative year, with a distinct complication profile. The rankings reported here are hypothesis-generating and should not by themselves determine device selection. Adequately large randomised comparisons with follow-up beyond one year are required.
Related
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- A Novel Reversible Tube Ligation Technique for Managing Hypotony After Paul Glaucoma Implant Surgery in Uveitic Glaucoma.
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BibTeX
@article{elshabrawi2026paul,
title = {{The Paul Glaucoma Implant versus the Ahmed and Baerveldt Glaucoma Implants: A Systematic Review and Bayesian Network Meta-Analysis.}},
author = {Mohamed N Elshabrawi and Bara M Hammadeh and Ayodeji Arobo and Nader Elfar and Elsayed S Moubarak and Rami Al-Dwairi and Seren Al Beiruti and Hashem Abu Serhan},
journal = {Clinical ophthalmology (Auckland, N.Z.)},
year = {2026},
month = oct,
doi = {10.2147/opth.s640039},
url = {https://europepmc.org/article/MED/42893085},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - The Paul Glaucoma Implant versus the Ahmed and Baerveldt Glaucoma Implants: A Systematic Review and Bayesian Network Meta-Analysis.
AU - Mohamed N Elshabrawi
AU - Bara M Hammadeh
AU - Ayodeji Arobo
AU - Nader Elfar
AU - Elsayed S Moubarak
AU - Rami Al-Dwairi
AU - Seren Al Beiruti
AU - Hashem Abu Serhan
PY - 2026
DA - 2026/10/13
JO - Clinical ophthalmology (Auckland, N.Z.)
DO - 10.2147/opth.s640039
UR - https://europepmc.org/article/MED/42893085
AB - Purpose To compare the efficacy and safety of the Paul Glaucoma Implant (PGI) with those of the two established glaucoma drainage devices, the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI).Methods PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, ScienceDirect and Google Scholar were searched. Eligible studies were randomised or comparative observational studies reporting outcomes in patients who received the PGI alongside a concurrent AGV or BGI comparator. The primary outcomes were intraocular pressure (IOP) reduction, surgical success rate, and reduction in glaucoma medications. A Bayesian network meta-analysis was performed, with treatment ranking summarized by surface under the cumulative ranking curve (SUCRA). Quality assessment and evidence certainty was performed using the Cochrane Risk of Bias tool and GRADE framework respectively.Results Five comparative studies (238 patients) were included. Relative to the AGV, the PGI was associated with a mean difference in IOP at 12 months of -3.344 (95% CrI -7.743 to 1.058) mmHg, and relative to the BGI of 4.387 (95% CrI -0.288 to 9.074) mmHg. Corresponding differences in medication number at 12 months were]-0.186 (95% CrI -0.858 to 0.545) and 0.444 (95% CrI -0.358 to 1.272). Credible intervals crossed the null for 29 of the 30 primary contrasts. Ranking probabilities favoured the AGV for IOP reduction from 3 to 12 months (SUCRA 0.885 to 0.976) and the PGI for early medication reduction (SUCRA 0.769 at 1 month), but these rankings were derived from imprecise estimates. Safety estimates were based on small numbers of events and several were unstable. Certainty of evidence was low to very low for most comparisons.Conclusion Within the limits of a small and predominantly non-randomised evidence base, the PGI achieved intraocular pressure and medication reduction broadly comparable to those of the AGV and BGI over the first postoperative year, with a distinct complication profile. The rankings reported here are hypothesis-generating and should not by themselves determine device selection. Adequately large randomised comparisons with follow-up beyond one year are required.
SN - 1177-5467
SN - 1177-5483
ER -