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

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.

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.