{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:07:10Z","timestamp":1779253630794,"version":"3.51.4"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Bonn"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      The PAUL\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Glaucoma Implant (PGI) is increasingly used in the surgical management of complex glaucoma, but detailed evaluation of its subconjunctival bleb morphology remains challenging due to its posterior location. While ultrasonography has long been used for bleb imaging, anterior segment optical coherence tomography (AS-OCT) offers higher-resolution imaging of anterior structures. This study aimed to directly compare ultrasonography and AS-OCT in assessing bleb morphology following PGI implantation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective observational study, 20 patients (21 eyes) with PGI underwent postoperative assessment with both AS-OCT and B-scan ultrasonography. Bleb configuration (single- vs. double-layered), bleb height, and spatial extension were evaluated and compared between modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age was 64.0 years (SD\u2009=\u200916.6); 80% were male. Sonography identified double-layered blebs in 95.2% of eyes, compared to 47.7% with AS-OCT, which failed to fully visualize bleb layers in 38.1% of eyes. Sonography consistently measured greater bleb heights and lengths than AS-OCT (total bleb height 3.76\u2009\u00b1\u20091.39\u00a0mm vs. 1.77\u2009\u00b1\u20090.71\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; maximum bleb length 17.24\u2009\u00b1\u20093.17\u00a0mm vs. 2.85\u2009\u00b1\u20091.03\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sonography provided more comprehensive visualization of PGI blebs, particularly in detecting double-layered configurations, total height and measuring full posterior extension, whereas AS-OCT offered detailed anterior segment assessment including the tube entry site and patch graft. Both modalities yield complementary information, and their combined use may enhance postoperative monitoring and early detection of bleb dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-026-07276-3","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:17:16Z","timestamp":1779250636000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sonography versus anterior segment OCT for imaging bleb morphology after glaucoma drainage device surgery"],"prefix":"10.1007","author":[{"given":"Pascal","family":"Schipper","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Aretz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonie","family":"Bourauel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Deubel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Petrak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank G.","family":"Holz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffael","family":"Liegl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Mercieca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance","family":"Liegl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"7276_CR1","first-page":"43","volume":"59","author":"AA Aref","year":"2017","unstructured":"Aref AA, Gedde SJ, Budenz DL (2017) Glaucoma Drain Implant Surg Dev Ophthalmol 59:43\u201352","journal-title":"Glaucoma Drain Implant Surg Dev Ophthalmol"},{"issue":"12","key":"7276_CR2","doi-asserted-by":"publisher","first-page":"3202","DOI":"10.1038\/s41433-021-01595-x","volume":"35","author":"ICF Pereira","year":"2021","unstructured":"Pereira ICF et al (2021) Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions. 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J Glaucoma 33(7):478\u2013485","journal-title":"J Glaucoma"},{"issue":"(10)","key":"7276_CR5","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1097\/IJG.0000000000002457","volume":"33","author":"C Weber","year":"2024","unstructured":"Weber C et al (2024) Two-year clinical outcomes of the PAUL\u00ae glaucoma implant in White patients with refractory glaucoma. J Glaucoma. 33(10):808\u2013814. https:\/\/doi.org\/10.1097\/ijg.0000000000002457","journal-title":"J Glaucoma"},{"key":"7276_CR6","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1038\/s41433-021-01737-1","volume":"36","author":"NA Vallabh","year":"2021","unstructured":"Vallabh NA et al (2021) Surgical technique, perioperative management and early outcome data of the PAUL\u00ae glaucoma drainage device. 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Approval was granted by the institutional review board of the University Hospital Bonn (approval number: 2024-17-BO & 091\/22). Informed consent was obtained from all individual participants included in the study and the authors affirm that participants provided informed consent for publication of the images in Figures 1 and 2.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval & Informed Consent"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Journal editorial board member and co-author Frank Holz had no role in reviewing this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical Trial Number"}}]}}