{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:54:12Z","timestamp":1787496852070,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"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":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The PAUL glaucoma implant (PGI) is a novel valveless glaucoma drainage device featuring a large endplate surface area to enhance aqueous absorption, as well as a smaller internal and external tube diameter to minimise postoperative hypotony and corneal endothelial damage, particularly in eyes with refractory glaucoma. This is the first meta\u2010analysis on the clinical efficacy and safety of the PGI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medline, Embase and CENTRAL databases were searched for articles on the use of the PGI. A meta\u2010analysis of single means and binary outcomes was conducted to assess clinical endpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 15 studies with 640 eyes were analysed. At the 12\u2009months postoperatively, the mean reduction in IOP and IOP\u2010lowering medications from baseline were 16.11\u2009mmHg (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200913,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009550, 95% CI: 12.91\u201319.31\u2009mmHg,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996.10%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 2.34 (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200912,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009482, 95% CI: 1.99\u20132.69,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200991.90%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), respectively. The mean complete and qualified success rates at 12\u2009months postoperatively were 50.22% (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20098,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009209, 95% CI: 38.73%\u201361.70%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980.30%) and 92.40% (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200911,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009490, 95% CI: 88.83%\u201395.40%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200941.40%), respectively. Postoperative complications such as hypotony (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200913,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200939, 6.05%, 95% CI: 2.81%\u201310.16%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200957.70%) and hyphema (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200913,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933, 5.63%, 95% CI: 2.52%\u20139.61%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200956.60%) were uncommon, and sight\u2010threatening complications such as corneal decompensation and endophthalmitis were rare. There was no statistically significant difference in mean visual acuity compared to baseline (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20097,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009312, MD: \u22120.03 logMAR, 95% CI: \u22120.09\u20130.04 logMAR,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.00%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.43).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta\u2010analysis provides quantitative evidence supporting the clinical efficacy and safety of the PGI in patients with refractory glaucoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ceo.70019","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T02:25:01Z","timestamp":1762223101000},"page":"221-232","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Efficacy and Safety of the\n                    <scp>PAUL<\/scp>\n                    Glaucoma Implant: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9784-2623","authenticated-orcid":false,"given":"Kai En","family":"Chan","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole Shu\u2010Wen","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cecilia","family":"Aquino","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Teck Chang","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine Wanxian","family":"Lun","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn Ka Ann","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seng Chee","family":"Loon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Tec Kuan","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-6194","authenticated-orcid":false,"given":"Marcus Chun Jin","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology National University Hospital  Singapore Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mjafi.2015.12.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0301\u20104738.73692"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000002369"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogla.2020.05.001"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000002360"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ceo.14235"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.15668"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000001969"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433\u2010021\u201001737\u20101"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000002366"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3980\/j.issn.1672\u20105123.2023.10.01"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.14744\/bej.2024.96729"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.17443"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/11206721251313835"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S505220"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/sjopt.sjopt_164_24"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.4103\/IJO.IJO_2595_24"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u2010135"},{"key":"e_1_2_7_20_1","unstructured":"Checklist for Systematic Reviews and Research Syntheses \u201cCritical Appraisal Tools for Use in JBI Systematic Reviews \u201dhttps:\/\/joannabriggs.org\/ebp\/critical_appraisal_tools."},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.12"},{"key":"e_1_2_7_23_1","unstructured":"RC Team \u201cR: A Language and Environment for Statistical Computing \u201d2024 http:\/\/www.r\u2010project.org\/."},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000001998"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000002457"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000543748"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433\u2010024\u201003527\u2010x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00347\u2010022\u201001669\u20105"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.05.004"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.07.016"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2020.08.20"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/ceo.14549"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2011.10.024"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109394(00)00538\u20109"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12886\u2010015\u20100115\u2010y"}],"container-title":["Clinical &amp; Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ceo.70019","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ceo.70019","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ceo.70019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:42:47Z","timestamp":1773207767000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ceo.70019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":34,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/ceo.70019"],"URL":"https:\/\/doi.org\/10.1111\/ceo.70019","archive":["Portico"],"relation":{},"ISSN":["1442-6404","1442-9071"],"issn-type":[{"value":"1442-6404","type":"print"},{"value":"1442-9071","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]},"assertion":[{"value":"2025-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}