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New research · Ophthalmology
Acta ophthalmologica · 2d
Cohort studyActa ophthalmologica · 2026

Longitudinal changes in bleb morphology following the PAUL Glaucoma Implant visualized using ultrasonography.

Constance Liegl, Benjamin Aretz, Leonie Bourauel … Karl Mercieca
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OphthalmologyCohort study

Bleb height roughly doubled after glaucoma drainage device surgery, then stabilized by 3 months.

Longitudinal changes in bleb morphology following the PAUL Glaucoma Implant visualized using ultrasonography.

Constance Liegl … Karl Mercieca
Acta ophthalmologica · 2026
Purpose

To evaluate bleb morphology longitudinally using sonography following glaucoma drainage device (glaucoma drainage device) surgery.

Methods

Prospective observational cohort study conducted from January 2022 to March 2024, with follow-up up to 12 months postoperatively.

Results

average bleb size at 3 months, when it leveled off

2.33mm
Day 14
4.14mm
Month 3
4.21mm
Month 12
More results

Preoperative mean IOP was 23.6 mmHg (range, 13-42) on 3.2 medications.

Mean IOP decreased to 12.7 mmHg at day 14 and remained between 13 and 15 mmHg through 12 months, while medication use declined to 0.9 drops.

Mixed-model analysis showed that absolute bleb height was significantly associated with higher IOP (β = 0.86, p = 0.043), independent of time.

More results

Accelerated bleb enlargement within the first 3 months correlated with higher IOP (β = 3.57, p = 0.003), whereas later changes showed no consistent associations.

“
Conclusion · 1 of 3

Ultrasound imaging revealed progressive bleb enlargement after PGI implantation, stabilizing by 3-6 months.

Conclusion · 2 of 3

In the subgroup of patients who completed the 12-month follow-up, IOP reduction remained stable throughout the first postoperative year.

Conclusion · 3 of 3

Absolute bleb height showed a consistent association with IOP across time, whereas early growth rate was only predictive during the early postoperative period.

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