The PAUL glaucoma implant (PGI) seems to have results similar to the Baerveldt implant due to its non-restrictive design. Although very scarce experience has been reported with the PGI, it seems to be a promising device, not so different to others already available. Glaucoma in African persons imposespecific challenges (higher IOP values, more rapid disease progression, stronger genetic predisposition, greater proclivity to develop dense scar after glaucoma surgery), so when a aqueous humor drainage device is indicated a more relevant decision to make, in my opinon, is not what device to select but what dose of mitomycin C (or 5-FU) to administer. Although MMC use in tube surgery is under debate, Alvarado et al (Am J Ophthalmol 2008;146:276) and Zhou and colleagues (BMC Ophthalmol 2014;14:107) demonstrated very good levels of efficacy and safety. Use of antimetabolites might be worthwhile to explore in African patients with refractory glaucoma