{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:42:06Z","timestamp":1787496126799,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate 2\u2010year outcomes and complications following primary PAUL Glaucoma Implant (PGI) surgery using an external tube ligation technique without intraluminal stenting or antimetabolites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective study included 85 eyes of 85 consecutive patients with medically uncontrolled glaucoma undergoing primary glaucoma surgery. Fixed 24\u2010month outcomes were available for 80 eyes. All procedures were performed by a single surgeon using external tube ligation with two 6\u20130 polyglactin sutures. Success was defined as IOP between 6 and 21\u2009mmHg with \u226520% reduction from medicated baseline, categorised as complete (no medications) or qualified (with medications). Preoperative and postoperative outcomes were compared using paired analyses. Kaplan\u2013Meier analysis estimated cumulative success, and logistic regression evaluated factors associated with choroidal effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean IOP decreased from 33\u2009\u00b1\u20098 to 12\u2009\u00b1\u20094\u2009mmHg at 24\u2009months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), corresponding to a 62% reduction. Medications decreased from 4.1\u2009\u00b1\u20090.9 to 1.0\u2009\u00b1\u20091.2 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). At 24\u2009months, complete and qualified success rates were 43% and 84%, respectively. Choroidal effusion occurred in 25 eyes (29%) and three required surgical drainage. More preoperative medications were associated with choroidal effusion after adjustment for treated preoperative IOP (OR 1.87, 95% CI: 1.03\u20133.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040). No endophthalmitis occurred. Exfoliation glaucoma showed higher complete success than other glaucoma types (54% vs. 31%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Primary PGI implantation using external ligation achieved substantial two\u2010year IOP and medication reduction. Early choroidal effusion was relatively common but usually self\u2010limiting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70206","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:30:18Z","timestamp":1785177018000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Two\u2010year outcomes of primary PAUL glaucoma implant using tube ligature technique without intraluminal stent"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3729-7343","authenticated-orcid":false,"given":"Jyri\u2010Pekka","family":"Koskinen","sequence":"first","affiliation":[{"name":"Department of Ophthalmology P\u00e4ij\u00e4t\u2010H\u00e4me Central Hospital  Lahti Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juha","family":"V\u00e4lim\u00e4ki","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology P\u00e4ij\u00e4t\u2010H\u00e4me Central Hospital  Lahti Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Geneid","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology P\u00e4ij\u00e4t\u2010H\u00e4me Central Hospital  Lahti Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0103-1581","authenticated-orcid":false,"given":"Mika","family":"Harju","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1111\/j.1600-0420.2007.00980.x","article-title":"Incidence and prevalence of pseudoexfoliations and open\u2010angle glaucoma in northern Sweden: II. 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