Clinical Report: Anterior Segment OCT Biomarkers in Early Postoperative Phase

Overview

This study evaluates the predictive value of anterior segment optical coherence tomography (AS-OCT) parameters, specifically bleb wall thickness (BWT) and total bleb height (TBH), in the early postoperative phase following Preserflo MicroShunt (PM) surgery. The findings indicate that these parameters do not significantly correlate with the need for secondary interventions or with bleb vessel density (BVD).

Background

Glaucoma treatment often involves surgical options to lower intraocular pressure (IOP), with filtration surgeries like Preserflo MicroShunt (PM) gaining traction. Understanding postoperative bleb function is critical, as many patients require secondary interventions. Accurate predictive biomarkers are essential for optimizing patient management and outcomes in glaucoma surgery.

Data Highlights

No significant associations were found between BWT/TBH and secondary interventions at 1, 2, and 4 weeks post-surgery (p-values: 1 W: 0.217/0.878, 2 W: 0.670/0.528, 4 W: 0.171/0.430).

Key Findings

• 10 out of 23 patients required secondary interventions between 4 and 48 weeks post-PM implantation.
• No significant correlation was found between BWT or TBH and future secondary interventions.
• BVD was previously identified as a potential predictor for secondary interventions, contrasting with BWT/TBH findings.
• AS-OCT parameters have been shown to correlate with bleb function after trabeculectomy but not after PM implantation.
• Larger studies are needed to confirm these findings and explore the predictive value of AS-OCT parameters further.

Clinical Implications

The lack of predictive value for BWT and TBH in the early postoperative phase suggests that clinicians should consider alternative biomarkers, such as BVD, for assessing the risk of secondary interventions after PM surgery. This may lead to more personalized follow-up strategies for glaucoma patients.

Conclusion

The study highlights the limitations of using structural AS-OCT parameters as predictive tools for postoperative outcomes following PM implantation, emphasizing the need for further research in this area.

References

1. Dorairaj SK, Batton KA, Glaucoma Physician, 2018 -- The Role of Imaging in Microinvasive Glaucoma Surgery
2. Dorairaj SK, Stewart MW, Ophthalmology Management, 2014 -- Anterior-segment OCT in glaucoma management
3. Flamendorf JS, Glaucoma Physician, 2022 -- Anterior-segment Imaging in Glaucoma
4. European Glaucoma Society, British Journal of Ophthalmology, 2025 -- Terminology and guidelines for glaucoma, 6th Edition
5. ScienceDirect, 2023 -- Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study
6. Ophthalmology Management — Expanding OCT to the Anterior Segment
7. OCT-Angiography and Glaucoma - EyeWiki
8. European Glaucoma Society – Terminology and guidelines for glaucoma, 6th Edition | British Journal of Ophthalmology
9. Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study - ScienceDirect