Background <p>To evaluate the long-term efficacy and safety of the Paul Glaucoma Implant (PGI) in a paediatric cohort.</p> Methods <p>A retrospective review of 113 eyes from 83 paediatric patients (age range 4 months to 18 years, mean 9 ± 5 years) who underwent PGI implantation between June 2019 and April 2024. Intraocular pressure(IOP), medications, complications, and surgical success rates were assessed.</p> Results <p>The mean preoperative IOP was 27.2 ± 6.2 mmHg. Postoperatively, IOP significantly decreased at all time points (<i>p</i> &lt; 0.001), measuring 14.0 at 12 months, 13.7 at 24 months, 12.5 at 36 months, 12.5 at 48 months, and 13.7 at 60 months. The mean number of preoperative medications was 3.8 ± 0.8. Postoperatively, they were 0.9 at 12, 18, and 24 months, 0.7 at 36 months, 1.0 at 48 months, and 0.7 at 60 months (<i>p</i> &lt; 0.001). 59% of eyes were medication-free at final follow-up. Thirty-nine eyes (35%) underwent Prolene stent removal (mean 9.7 months post-op), resulting in further IOP reduction (14.3 mmHg) and medication (0.8). Complete success rates (IOP ≤ 21 mmHg without medication) were 67.2% at 1 year, 58.2% at 2 years, 51.9% at 3 years, 50.1% at 4 years, and 49.3% at 5 years. Qualified success rates (IOP ≤ 21 mmHg with or without medication) were 91.2%, 88.5%, 85.8%, 85.0%, and 81.4% at the same intervals. 31(27.4%) eyes required further surgical intervention, most commonly for IOP control(21.2%). Major complications included tube exposure(2.7%) and hypotony(2.7%).</p> Conclusion <p>PGI demonstrates sustained IOP reduction, reduced medication burden, and an acceptable safety profile in refractory paediatric glaucoma. It represents an effective long-term surgical option for this challenging cohort.</p>