Experience with Paul aqueous shunt

[MeoWow]

Hi everyone - has anyone got any experiences with Paul aqueous shunt implant surgery? Please can you share your thoughts on it? I will be having one in the next few weeks and I would be grateful for any useful information and recovery experiences to manage expectations and plan work activities. Thank you all!

[Magnatawan]

hi, I had a Paul implant in April 2023 and I felt rough for about a week after but I think is is mainly because I chose to have a sedative. The surgery is uncomfortable but not painful. It took a couple of months before I could do things like swimming, diy, exercises etc The big advantage of the shunt over a trabeculectomy is that it is far less susceptible to infection which is great if you do lots of outdoor adventure or remote stuff. Unfortunately, the tube in the implant was not well placed so slurped onto my iris and stopped working. I have only just had it fixed when I had the cataract done. Key thing is make sure they take you off the steroids within a couple of months of the op. I was left on them for a year and think this ‘supercharged’ my cataract which went from insignificant to advanced in a year. This wasn’t to do with the Paul though but the steroid eye drops. I am very much hoping that after this op that the Paul will be working fine and keep my eye presssure low and mean I can do all sorts of outdoor adventure stuff again. Hope this helps

[MeoWow in reply to Magnatawan]

Thank you Magnatawan. Interesting point about the Steroids. I already have Cataract due to my retinal detachment surgery and taking too much dexamethasone (Maxidex), once the shunt implant has settled down they will be doing the Cataract surgery as i can't see much at all in one eye at the moment. Just a quick question, does your other non operated eye have any impact due to the shunt implant / medications ? Good luck with your outdoor adventures! Cheers, SJ

[Rainyday2024]

Hello MeoWow! I saw your post late last night and thought I must write to you today about my own experience of having a Paul implant. I had mine done under general anaesthetic almost 14 weeks ago. I was fortunate enough to be able to afford to go privately, mainly because I wanted to be sure of getting a particularly well recommended surgeon and also I didn’t know how long I’d have to wait if I went NHS! I don’t know how much detail you would like - I will try to keep it as brief as I can, but please ask me anything else you want to know! Surgery took two hours at hospital in Birmingham. Allowed home same day with bandage and plastic eye shield like you have with cataract surgery. Had to visit surgeon following morning for check up, all seemed good. Wore eye shield in bed for about two weeks to be on the safe side. Drops!! Hundreds of them - thank goodness for my alarm in my mobile! I found writing daily lists of the various drops and ticking them off was a great help. Luckily I am retired and could spend the early days at home. No lifting anything too heavy nor bending from the waist during the first week or so - they will tell you all this. Careful when showering and didn’t wash my hair for about two weeks! I have quite long hair but used a dry shampoo a couple of times. Aftercare visits to consultant (same chap who did my op) - once a week for four weeks, then fortnightly for a couple of weeks, reducing down to monthly (??) to yesterday when I last saw him. Yes, it’s all pretty full on but our eyes are SO important. At least now the drops have been greatly reduced - now just morning and evening. He seemed very pleased at my visit yesterday, but I am due to have another stitch removed (under local anaesthetic) two weeks today as the pressure is still a little higher than he’d like. He didn’t do this until my eye had settled down and I was off the steroid drops, as they can increase eye pressure - on the other hand, you don’t want the pressure to go too low, so it’s all a bit of “fine tuning”. I hope this has helped as I know how worried I felt before I decided to have the Paul tube fitted. I couldn’t have trab for various reasons and so the Paul was recommended. Unfortunately, the other person who replied to you seemed to have had a rather bad experience and I was concerned it might put you off having the surgery. I hope I have given you some encouragement, and not bored you to death with my very long reply!! Kind regards, Gill

[MeoWow in reply to Rainyday2024]

Thanks Gill for your reply. Lot of insights and greatly appreciate your patience in going into details on post operation recovery experience. I do need to hear this to manage my expectation and plan work things. I'm also having this done under general anaesthetic at Moorfields and good to hear it went well for you!

I do have another follow up question. I'm getting the implant done in my left eye, does using steroids and various other drops affect your other eye ? I do have glaucoma on the right eye but its being managed by Latanoprost eye drops, did they give you drops for your other eye to avoid the increase in pressure ? Cheers, SJ

[Rainyday2024 in reply to MeoWow]

Hello again! I’m so glad you found my reply helpful. It’s good that you’re having it done under general anaesthetic because it’s quite a long op (about two hours) and I wouldn’t have wanted to be awake during the surgery. It was the first time I’d ever had an operation, so that added to my worries! My consultant/surgeon used to work at Moorfields - Mr Imran Masood. He is now mostly based in and around the Birmingham area, both doing NHS and Private. My NHS Glaucoma consultant in Rugby, where I live, recommended him as being one of the top surgeons for this sort of operation. I have Glaucoma in both eyes, but my right eye was evidently much worse, with hardly any sight left. I put off having the operation for about two years, but of course, my eye got worse. I know it won’t bring the sight back, but should hopefully prevent it getting any worse. Before the operation, I was on three different types of drops in both eyes - Ganfort (just in the morning - gave me lovely long lashes!), Trusopt (Dorzolamide) twice a day plus Brimonidine also twice a day. Then Thealoz for dry eyes - so quite a cocktail, eh? Now, after the Op, I am still using the same drops in my left (unoperated) eye. In my right eye (implant eye) at the moment I am using Cosopt twice a day plus Brimonidine also twice a day. I stopped using the steroids in my operated eye a couple of weeks ago, as the consultant wanted to gradually wean me off them. When I put any drops in, I try to do the “pressing the tear duct by my nose using my fingertip” trick - as this is supposed to prevent the drops getting into your system - or something! I am sure they must still enter your bloodstream though, sometimes I can taste them in my throat so maybe I’m not doing the pressing thing properly or for long enough? I never used to do it at all - it wasn’t until I read about it on here that I began trying to do it! I don’t know whether I’m suffering any side effects from all these drops, but my lower legs and ankles tend to feel a bit swollen. I’ve read that Timolol can have adverse effects. The consultant said yesterday that he is going to re-think the drops I am using as it’s quite a mixture! Hope this helps - and that you have a good weekend. Regards, Gill PS feel free to ask anything else!

[MeoWow in reply to Rainyday2024]

Thanks Gill! I have also tried the tear duct technique but same as you i get the taste in the throat so not sure whether it works or i'm doing it correctly..

[Magnatawan]

hi, fortunately I haven’t developed glaucoma in my right eye despite having primary closed angles. With luck the laser surgery and drops will prevent glaucoma developing in that eye. I can now see masses more out of my left eye now they have removed the cataract (mind, I can also see how much I can’t see out of that eye due to the glaucoma damage!) I don’t think having the implant and cataract has affected my other eye at all. The treatment and drops have been quite different and independent in each eye. Good luck with your surgery and just give everything time to settle down (at least that’s what I keep telling myself!😂) let us know how it all goes

[MeoWow in reply to Magnatawan]

Thanks M! That's really lucky you haven't got the pressure in the right eye! How long did it take for them to do the cataract surgery after the shunt implant operation ? I do have cataract in my left eye on which they will be doing the implant surgery and my vision is very limited due to cataract but its not too bad with the pin hole...

[Magnatawan]

hi, it was 15 months after- I think they like the eye to settle after the implant before doing anything else

[MeoWow in reply to Magnatawan]

Thanks M. Hopefully it will settle soon and i will get the cataract done after that...

[Rainyday2024]

Hello MeoWow,

How’s things? Have you had your Paul tube implant yet? If so, I hope all went well and you are making a full recovery. I am very interested to know how you are getting on!

Regards, Gill

[MeoWow in reply to Rainyday2024]

Hello Gill - I'm good, thanks. I hope you are well too. My implant operation is scheduled next week (3rd Sept). Thank you for following up!

[Rainyday2024 in reply to MeoWow]

Hope all goes well with your Op tomorrow. Kind regards, Gill

[MeoWow in reply to Rainyday2024]

Thank you Gill!

[MeoWow]

Hi guys, so I've had the shunt implant. The op was 2 days ago and I've got double vision. Did any of you get that and did it clear up on it's own?

[Rainyday2024 in reply to MeoWow]

Hello again MeoWow,

I hope the op went well and your double vision has now settled down and that you are managing all the numerous eye drops!! I had to set alarms on my mobile otherwise I would never have been able to remember them all, especially the two-hourly steroid ones. It will get easier though as the weeks go by and the drops get further and further apart. It all becomes part of a routine, obviously easier if you are at home most of the day, not so easy if you have appointments or go out to work for example. I sometime get a bit of a ghost image in my operated right eye, but I’ve had that for quite a while so don’t think it’s anything to do with the shunt operation. A week or so ago, my consultant removed a suture from the tube as my pressure was still a bit high. I had a local anaesthetic (drops) and it only took a few minutes. Not painful, just a little uncomfortable. Wishing you a good recovery - it will be 19 weeks on Sunday since my op. Regards, Gill

[MeoWow in reply to Rainyday2024]

Thank you Gill, yes the double vision has reduced but it's still there, hopefully it will sort itself out soon. Thanks for the tip on managing the drops!

[Culurgionis]

Hi Paul,have just connected here for the same reason as you.I too have been offered the aqueous shunt implantation but have said I would think about it as I had never heard of this procedure before.I am guessing that you may by now have had it done? I hope it was successful.I certainly would like to find out more about it before going ahead.Thank youMADV

[Culurgionis]

Hi Meo meo,have just re read all the messages and have realised I got your name wrong.I shall try to continue to follow you on your recent op.Get well soon.MADV

[MeoWow in reply to Culurgionis]

No worries about the name

Its been slightly over a month since i had the implant and here are my observations / thoughts which might be helpful to put your mind at rest.

Procedure:

I got the shunt implant done with General anaesthetic (if you are offered this option then in my experience its the best way to get it done but please consult with your doctor as they are in the best place to assess your needs)

I was anxious about the procedure and pain but it was ok and reading other forum members experiences was reassuring. It's more discomfort than pain and it was ok after few days as the post operation drops helps to heal things fast.

Some recovery notes below:

- My eye pressure has been lowered after the shunt.

- Clear your diary as there will be lot of regular weekly appointments.

- Lot of eye drops every 2 hours. (use phone reminders / timers)

- I have glaucoma in both eyes and prolonged steroid use have increased the pressure on the un-operated eye and that is being currently managed by drops so nothing to worry here but just FYI.

- I experienced double vision as the implant sits on the eye muscle and now its getting better and i was told it can taken few months to settle.

I hope the above notes are helpful, if you need anything else, please feel free to ask...

Good luck with your surgery!

[Rainyday2024 in reply to MeoWow]

Hello again! Hope you are getting on ok after your Paul implant. I have an appointment later today with my consultant, not seen him for a couple of months. He changed my drops the last time I saw him, now on Cosopt twice daily and Monopost once daily, in the evening. I hope this new regime is working to keep my pressures down to an acceptable level. As a matter of interest, have you had to have any more procedures, such as stitches or sutures removed following the implant? Regards, Gill

[MeoWow in reply to Rainyday2024]

Hi Gill - I hope you are well. Thanks for following up. Yes I had my stitches from the operation removed two weeks ago and the pressure is not bad but they want it to go down bit more, I'm on cosop twice, iopidine thrice and monoprost once in the evening. They want to remove the suture in three weeks time and hopefully that will stabilise the pressure and I can move on to get the cataract sorted...

How did your appointment go? Has there been any progress with the pressure?

All the best, M

[Rainyday2024 in reply to MeoWow]

Hi, Good to hear from you and that you seem to be progressing well. Apart from the iopidine drops, you sound in a similar situation to me. Hopefully once the suture is removed, your pressure will drop (but not too much!) and you might be able to stop some of the drops.

My appointment went well, thanks and he is very pleased with the outcome. The pressure in the operated eye was 14, unoperated eye 18. I’d have thought he was looking for lower readings, but he’s the boss and he seemed happy! I was hoping to be able to stop using drops after the Paul implant, but like I said, if the consultant is happy then so am I. He got me to read the wall chart and he thought the vision in the operated eye had improved slightly, which is great. I’m seeing him again in three or four months, when he will do a visual field test, which I hate because I know I miss so many lights. It will be interesting to see whether it’s improved from my last field test, which was ages ago, well before the operation. Kind regards, Gill

[Culurgionis]

Bless you and thank you.Most reassuring.