PAUL Glaucoma Implant surgery and mitomycin C

Mitomycin C (MMC), an antifibrotic agent that is often utilised in trabeculectomy, has demonstrated variable efficacy when used as an adjunct in glaucoma drainage device (GDD) surgery. Although the rationale for MMC use in GDD implantation is similar to its application in trabeculectomy—namely, to reduce fibrotic encapsulation and improve bleb function—clinical studies provide conflicting evidence regarding its long-term benefits. MMC may transiently reduce intraocular pressure (IOP), medication burden, and hypertensive phases, particularly in Ahmed Glaucoma Valve (AGV) procedures, according to randomised trials and retrospective series. Nevertheless, these advantages frequently diminish within 6–12 months, and there is no consistent increase in surgical success rates. Additionally, adjunctive MMC in PAUL® Glaucoma Implant (PGI) surgery for neovascular or refractory glaucomas has been linked to improved early IOP control and fewer postoperative interventions; however, the long-term efficacy of this approach remains uncertain. We present 2 cases of PGI implantation with intraoperative MMC: a young patient with aphakic glaucoma and a monocular patient with sympathetic ophthalmia and advanced glaucoma. In the mid- to long-term, both exhibited sustained IOP control without the necessity for suture lysis or significant complications. The selective use of MMC in high-risk eyes, where the risk of fibrosis is high and long-term bleb function is critical, is justified by these findings. The individualised application of MMC in GDD surgeries remains