In short: the PAUL Glaucoma Implant is a small silicone tube with a soft plate, stitched to the white of the eye, that channels fluid away to lower pressure. Its very fine 0.127 mm channel gives the reliable low pressures (typically 12–14 mmHg) needed for severe or complex glaucoma — including eyes where trabeculectomy, Xen or PreserFlo have failed — with fewer early complications than older tube designs.
What is the PAUL glaucoma implant?
When glaucoma is advanced or aggressive, when the conjunctiva is scarred from previous surgery, or when bleb-forming operations have failed, a tube (drainage implant) is the most dependable way to control pressure. A small tube carries fluid from inside the eye to a reservoir on a plate fixed to the eye wall 8–10 mm back, where it is gently absorbed.
The PAUL Glaucoma Implant is a modern device with a notably small 0.127 mm internal channel and a low-profile plate. The narrow channel and a temporary stitch that holds it closed early on help prevent the very low pressures (hypotony) that can complicate tube surgery, while still delivering strong long-term control. In UK and international studies it achieves an average pressure of 12–14 mmHg at one to two years with 60–75% of patients reducing or stopping drops — with fewer early hypotony, tube-cornea touch and corneal cell-loss problems than the older Baerveldt 350.
Your options
Tube surgery is reserved for glaucoma that needs a dependable low pressure. Your consultant will confirm whether PAUL is the right operation for your eye.
Has previous glaucoma surgery stopped working, or is your pressure still too high? A consultant assessment will set out your best option.
Book your assessmentHow the procedure works
PAUL implantation is a day-case operation, usually under a local anaesthetic block with sedation (general anaesthetic is available if you prefer). You feel pressure and movement but no sharp pain.
Before — assessment
Your consultant confirms the type and stage of your glaucoma with pressure checks, gonioscopy, OCT of the optic nerve, visual fields and a corneal cell count, and plans which quadrant the tube will sit in.
In theatre — the implant
The plate is stitched to the eye wall behind the eyelid, the fine tube is placed into the front of the eye and held closed with a dissolvable stitch, and a small graft covers it where it enters. Everything is hidden under the lining of the eye.
Same day — home
You go home the same day with a shield and a course of antibiotic and anti-inflammatory drops. The closing stitch releases over the following weeks as the reservoir matures.
Recovery
Vision is often blurry for two to six weeks while the temporary stitch releases and the reservoir settles — this is normal and expected with tube surgery. Most office workers are back at work within 7–10 days. Avoid heavy lifting, swimming, contact sports and eye-rubbing for about four weeks. You’ll attend reviews at day 1, week 1, around weeks 4–6 (to release the stitch), and at months 3, 6 and 12. Tube surgery is done one eye at a time, with at least 4–6 weeks between eyes so your surgeon can confirm the first eye is stable. Glaucoma needs lifelong monitoring afterwards.
Cost
At our partner clinics across southern England, private PAUL glaucoma implant surgery is typically £5,500–£7,500 per eye for a standard primary case, and £7,000–£9,000 per eye for a complex case (such as neovascular, uveitic or post-failed-trabeculectomy glaucoma). Combined with cataract surgery it is usually £7,500–£10,500, and combined with vitrectomy £8,500–£11,500. Quotes include the implant, surgeon, theatre and the 12-month aftercare package. Many patients spread the cost with 0% finance. Book a consultation from £240 for a personalised quote, or see our full price list.
Frequently asked questions
At our partner clinics in southern England, private PAUL implantation is typically £5,500–£7,500 per eye for a standard primary case and £7,000–£9,000 per eye for a complex case such as neovascular, uveitic or post-failed-trabeculectomy glaucoma. Combined PAUL plus cataract surgery is £7,500–£10,500 per eye, and combined PAUL plus vitrectomy is £8,500–£11,500. Quotes include the implant, surgeon, theatre and 12-month aftercare. Book a consultation from £240 for a personalised quote.
The PAUL Glaucoma Implant is a small silicone tube with a soft plate, stitched to the white of the eye, that drains fluid to a reservoir where it is absorbed. Its very fine 0.127 mm channel gives reliable low pressures, so it is used for severe, complex or refractory glaucoma — including neovascular and uveitic glaucoma, scarred conjunctiva, and eyes where a trabeculectomy, Xen or PreserFlo has failed. Many UK units now also offer it as a primary option in moderately advanced disease.
In UK and international studies the PAUL achieves an average pressure of 12–14 mmHg at one to two years, with about 60–75% of patients reducing or stopping their glaucoma drops by 6–12 months. Some eyes — those with very high starting pressure, neovascular glaucoma, or after combined surgery — still need one or two drops long term. No glaucoma operation restores sight already lost; the goal is to protect the vision you have by controlling pressure.
Compared with the older Baerveldt 350 tube, PAUL gives broadly similar long-term pressure control with fewer early hypotony, tube-cornea touch and corneal cell-loss problems, thanks to its smaller channel and low-profile plate. The bleb-forming options — Xen, PreserFlo and trabeculectomy — suit moderate open-angle glaucoma with healthy conjunctiva, whereas PAUL is preferred when the conjunctiva is scarred, the disease is aggressive, or earlier surgery has failed.
Vision is often blurry for two to six weeks while the temporary stitch releases and the reservoir settles. Most office workers return within 7–10 days; avoid heavy lifting, swimming, contact sports and eye-rubbing for about four weeks. Tube surgery is always done one eye at a time, with at least 4–6 weeks between eyes so your surgeon can confirm the first eye is stable before operating on the second.
Surgery is performed under local anaesthetic with sedation, or general anaesthetic by preference, so you feel pressure and movement but no sharp pain; a mild ache for a day or two afterwards settles with simple painkillers. Most UK private medical insurers (Bupa, AXA Health, Aviva, Vitality, WPA) cover PAUL implantation under glaucoma surgical codes with pre-authorisation — our team prepares the coded quote and medical justification your insurer needs.