AS-OCT–Based Biomarkers of Early Postoperative Bleb Morphology May Predict Surgical Success After PRESERFLO MicroShunt Implantation

Purpose: The purpose of this study was to identify early postoperative anterior segment optical coherence tomography (AS-OCT) biomarkers of bleb morphology that may predict surgical success following PRESERFLO MicroShunt (PMS) implantation in patients with glaucoma. Methods: Retrospectively, patients who underwent PMS implantation were included. AS-OCT imaging was performed 4 weeks after surgery. Qualitative (presence of conjunctival cysts and spaces, reflectivity of Tenon's capsule, and presence of an episcleral lake) and quantitative (maximal bleb length, height and width along with maximal episcleral lake length, height, and width) features were evaluated and surgical success 6 months after surgery was evaluated. Associations between these features and surgical success were analyzed. Results: Fifty-one eyes of 46 patients were included, 26 eyes (51%) met the success criteria for complete success (CS). Baseline characteristics were comparable between success and failure groups. The presence of an episcleral lake was significantly associated with later surgical success (odds ratio [OR] = 9.76, 95% confidence interval [CI] = 2.23-42.72, P < 0.01) and the maximum episcleral lake length (MLL), width (MLW), and height (MLH) were significantly higher in the success group compared to the failure group (3.18 ± 1.59 vs. 1.09 ± 1.63 mm, 3.04 ± 1.87 vs. 0.98 ± 1.4, 0.33 ± 0.2 vs. 0.15 ± 0.22, respectively, P < 0.05 for all). Lasso regression identified MLL and MLW as key predictors of success. A multivariable model incorporating these parameters achieved 79.1% accuracy (sensitivity 80.8% and specificity 77.3%) in predicting CS 6 months after the surgery. Conclusions: Early detection of an episcleral lake and its dimensions via AS-OCT may serve as a valuable predictor of surgical success following PMS. In contrast, conventional bleb parameters such as height, width, or wall reflectivity were not associated with outcomes. Translational Relevance: AS-OCT biomarkers could help predict surgical success following PMS.