For a study, researchers sought to determine the 2-year efficacy of the PAUL Glaucoma Implant (PGI), a novel glaucoma tube shunt, in patients with advanced glaucoma. Patients with glaucoma who have not responded to maximal medical therapy or had previous failed glaucoma surgery. Retrospective review of all patients who had PGI implantation at a single tertiary institution between May 1, 2017, and March 30, 2021. Failure was defined as intraocular pressure (IOP) of more than 18 mm Hg or less than 6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, implant explantation, or loss of light perception vision. In the absence of failure, complete success was defined as unmedicated IOP of less than equal to18 mm Hg or more than equal to 6 mm Hg. About 45 eyes in 45 patients were identified, with a mean follow-up duration of 24.9, somewhat about 2.0 months. A total of 30 patients (66.7%) had primary glaucoma, while 11 (24.4%) had previous glaucoma surgery. About 2 years after surgery, 8 eyes (17.8%) met the failure criteria, while 32 eyes (71.1%) were completely successful. In comparison to the mean medicated preoperative IOP (19.8±6.3 mm Hg), the postoperative IOP at 24 months was 13.9 plus minus 3.7 (P<0.01). The mean number of medications taken decreased from 3.2, somewhat about 0.8 before surgery, to 0.29, somewhat about 0.65 after 24 months (P<0.01). Self-limiting shallow anterior chamber (n=10; 22.2%), hypotony requiring intervention (n=4; 8.9%), and tube occlusion (n=4; 8.9%) were all significant complications. After 2 years of postsurgery, the PGI achieved sustained IOP reduction with medication reduction in patients with advanced glaucoma.