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In addition to a full ophthalmic exam, blebs were evaluated using Moorfield\u2019s Bleb Grading System (BGS), AS-OCT, IVCM, and ICA. AS-OCT metrics included bleb-wall and subepithelial cyst-like structure area and density (BECSA\/BECSD, BSCSA\/BSCSD), bleb height (BH), bleb thickness (BT), and epithelial thickness (BET). IVCM parameters included stromal meshwork reflectivity (SMR), goblet cell density (GCD), epithelial microcyst density and area (EMD, EMA), and dendritic cell density (DCD). ICA assessed MUC5AC and HLA-DR\/cell area ratio. Success was defined as an IOP\u2009&lt;\u200921 mmHg and \u2265\u200920% reduction at six months. Imaging parameters were correlated with surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At six months, 11 (55%) cases were classified as successful and 9 (45%) as failures. BGS showed significantly larger blebs in the success group (88.9% with maximal diffusion area grade\u2009\u2265\u20093 vs. 22.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). AS-OCT detected persistent epithelial and subepithelial changes in successful blebs, with significantly higher BECSA (0.11 vs. 0.02\u00a0mm\u00b2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.02). Preoperatively, successful cases showed higher GCD on IVCM (67.3 vs. 39.2 cells\/mm\u00b2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25) and mucin expression on ICA (MUC5AC\/cell ratio: 1.28 vs. 0.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.11). Postoperative IVCM also showed trends toward increased EMD in both groups, though not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Successful XGS blebs were associated with higher preoperative goblet cell density (IVCM) and mucin expression (ICA). Postoperatively, AS-OCT parameters\u2014especially epithelial and subepithelial changes\u2014showed the strongest correlation with IOP, highlighting AS-OCT as the most clinically applicable tool for monitoring bleb function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier NCT04727411, January 22, 2021.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-025-06952-0","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:11:35Z","timestamp":1759479095000},"page":"207-218","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal analysis of XEN45 gel stent bleb morphology using bleb grading scales, anterior segment-OCT, in vivo confocal microscopy, and impression cytology"],"prefix":"10.1007","volume":"264","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5446-7675","authenticated-orcid":false,"given":"N\u00e9stor","family":"Ventura-Abreu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca","family":"Molins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9","family":"Guerra-Meniconi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8084-7054","authenticated-orcid":false,"given":"Sara","family":"Labay-Tejado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sof\u00eda","family":"Porto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Jes\u00fas","family":"Muniesa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5171-165X","authenticated-orcid":false,"given":"Elena","family":"Mill\u00e0","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4094-6346","authenticated-orcid":false,"given":"Marta","family":"Pazos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"6952_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bjophthalmol-2023-egsguidelines","volume":"107","author":"L Abegao Pinto","year":"2023","unstructured":"Abegao Pinto L, Sunaric M\u00e9gevand G, Stalmans I et al (2023) European glaucoma Society - A guide on surgical innovation for glaucoma. 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The study was registered in the National Library of Medicine (clinicaltrials.gov, NCT04727411). Written informed consent was obtained from each participant in the study. The informed consent allowed publication in peer-reviewed journals.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"NVA is a lecturer, consultant, or has received grants from Allergan\/AbbVie, BRILL Pharma, Carl Zeiss Meditec, Laboratoirs Th\u00e9a, Glaukos, Amgen, and GlaxoSmithKline. MP is a lecturer, consultant, or has received grants from Allergan\/AbbVie, Laboratoirs Th\u00e9a, Santen Pharmaceutical, BRILL Pharma, Carl Zeiss Meditec, Glaukos, VISUFarma, Heidelberg Engineering, and Esteve. MJM is a lecturer, consultant, or has received grants from is a consultant or has received a research grant from Allergan\/AbbVie, Santen Pharmaceutical, BRILL Pharma, Glaukos, and Elios Vision. EM is a lecturer, consultant, or has received grants from Allergan\/AbbVie, Santen Pharmaceutical, BRILL Pharma, Glaukos, Elios Vision, Rheon Medical, and Advanced Ophthalmic Innovations. The rest of the authors have no competing interests to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were according to the ethical standards of the tenets of the Declaration of Helsinki (in the latest version, October 2024), and ethical approval was obtained from the Human Research Ethics Committee (HREC) of the Hospital Clinic of Barcelona, Barcelona, Spain (Reference number HCB\/2019\/0035).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants"}}]}}