Accuracy of toric intraocular lens implantation using automated vs manual marking.

BACKGROUND: Accurate alignment of toric intraocular lens (TIOL) to steep corneal astigmatic axis is important to achieve effective postoperative results. The authors compare the accuracy of astigmatism correction using automated and manual marking in TIOL implantation during cataract surgery. METHODS: One hundred thirty-two eyes with nuclear density from Grade 2 to 4 were randomly subdivided into 2 groups (automated and manual marking). All patients underwent manual marking and the steep axis was compared to SensoMotoric Instruments (SMI). After phacoemulsification, 62 patients underwent toric IOL implantation using the SMI and 70 patients underwent toric IOL implantation using manual marking. Intraoperative measurement was the steep axis difference. Clinical measurements included preoperative and postoperative best corrected visual acuity (BCVA), and TIOL axis. RESULTS: The intraoperative steep axis difference between SMI and manual marking was 7.86 ± 6.4 degrees. The difference between the preoperative steep axis and the postoperative TIOL axis using SMI (3.63 ± 1.12 degrees) was significantly lower than that using manual marking (8.29 ± 2.23 degrees) (P < 0.05). CONCLUSIONS: The steep axis measurements may be different when using SMI vs. manual marking. The SMI is more accurate than manual marking for TIOL implantation during cataract surgery. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12294725 , Retrospectively registered, on 20 July 2018.

Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E2 release during femtosecond laser-assisted cataract surgery.

PURPOSE: To determine the effects of topical 0.45% ketorolac tromethamine on intraoperative miosis and prostaglandin E2 (PGE2) release during femtosecond laser-assisted cataract surgery. SETTING: Seoul St. Mary's Hospital, Seoul, Korea. DESIGN: Prospective case series. METHODS: The study comprised the following 3 groups: conventional cataract surgery without topical NSAIDs (conventional group); femtosecond laser-assisted cataract surgery with preoperative topical ketorolac tromethamine 0.45% (femtosecond NSAID group), and femtosecond laser-assisted cataract surgery without topical NSAIDs (femtosecond no-NSAID group). To measure the aqueous humor PGE2 concentration, a 100 µL aqueous humor sample was collected from the anterior chamber after femtosecond laser pretreatment. The PGE2 concentration was measured using an enzyme immunoassay. RESULTS: Topical ketorolac tromethamine 0.45% led to a significant reduction in intraoperative miosis in the femtosecond NSAID group compared with the femtosecond no-NSAID group (P < .001). Absolute and relative reductions in pupil area in the femtosecond NSAID group were significantly lower than in the femtosecond no-NSAID group (P = .019 and P = .007, respectively). The mean aqueous humor PGE2 concentrations were 893.60 pg/mL ± 843.10 (SD) in the conventional group, 1911.43 ± 1178.63 pg/mL in the femtosecond NSAID group, and 743.63 ± 927.46 pg/mL in the femtosecond no-NSAID group (P < .001, conventional versus femtosecond NSAID and femtosecond NSAID versus femtosecond no NSAID; P > .05, conventional versus femtosecond NSAID). CONCLUSION: Preoperative topical ketorolac tromethamine 0.45% reduced miosis induced by femtosecond laser pretreatment and inhibited aqueous humor PGE2 elevation.

Comparison of Anterior Capsule Stability Following Implantation of Three Single Piece Acrylic Intraocular Lenses with Different Haptic Design.

PURPOSE: To compare the anterior capsule contraction and intraocular lens (IOL) decentration among three types of IOL to determine the influence of haptic design on anterior capsule stability. METHODS: One hundred fifty patients were enrolled in this prospective, randomized study and 260 eyes underwent implantation of one of the following IOLs: modified L-haptic IOL (n = 74), modified C-haptic IOL (n = 97), or a plate-haptic IOL (n = 89). The area of the anterior capsule opening, IOL decentration, and capsule overlap were measured using retroillumination photospot 1 day and 2 months after cataract surgery. RESULTS: The area of capsule opening at postoperative day 1 was significantly different between the three IOLs (p < 0.01). All IOLs showed reduction of the anterior capsule opening from 1 day to 2 months after surgery, and greater reduction was shown in the modified C-haptic IOL (p < 0.001). At postoperative month 2, IOL decentration was significantly different between the IOLs and showed a positive correlation with the mean area reduction during month 2. CONCLUSIONS: The degree of anterior capsule contraction and IOL decentration in modified L-haptic IOLs were less than those in modified C-haptic IOLs and comparable to those in plate-haptic IOLs.

Clinical Features of Infectious Keratitis Caused by Propionibacterium Acnes.

PURPOSE: Propionibacterium acnes is a commensal bacteria whose pathogenicity in infectious keratitis is unclear. In this study, we report infectious keratitis cultured with P. acnes and evaluate its clinical characteristics. METHODS: All cases of infectious keratitis submitted to the microbiology laboratory of St. Mary's Hospital of Seoul between January 2013 and April 2014 were reviewed. Nonpretreated cases that were positive for P. acnes were identified, and clinical characteristics and treatment outcomes were studied. RESULTS: Of 132 cultures submitted to the microbiology laboratory, 89 (67.4%) were positive for growth, and a total of 16 (17.9%) of the 89 cases yielded P. acnes in culture medium. Infectious keratitis that was positive for P. acnes was generally small (62.5%) with deep stromal infiltration (81.25%) and a peripheral location (56.25%). The average incubation period was 11.06±5.76 days, and the average time to reepithelialization was 23.50+13.52 days. All the cases of P. acnes evaluated in this report responded well to medical treatment. CONCLUSIONS: Infectious keratitis with P. acnes is not uncommon and can be confused with other Gram-positive cocci. Thus, P. acnes should be suspected in small-sized keratitis with an unusually long incubation period.

Useful Prediction of Phacodynamics by Scheimpflug Lens Densitometry in Patients over Age 70.

PURPOSE: To evaluate the relationship between lens density using the Scheimpflug system and phacodynamics in nuclear cataracts as related to patient age. METHODS: In 262 eyes with nuclear cataracts, the objective lens density was determined by Pentacam Nucleus Staging (PNS) software while subjective grading was achieved using the Lens Opacities Classification System III (LOCS III). RESULTS: Overall, cumulated dissipated energy (CDE) had a positive correlation with Scheimpflug lens density and LOCS III nuclear scores. When analysis was done by patient age, LOCS III nuclear scores and Scheimpflug lens density had a positive correlation with CDE for patients in all age groups. Of interest, patients >70 years old showed a higher correlation coefficient (r) with Scheimpflug lens density than with LOCS III nuclear score. CONCLUSIONS: Scheimpflug lens densitometry may be more useful for predicting phacodynamics than LOCS III scores in nuclear cataract patients, especially in old age (>70 years).

Comparison of Long-term Clinical Outcomes between Descemet's Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty in Patients with Bullous Keratopathy.

PURPOSE: To compare 2-year clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in patients with bullous keratopathy. METHODS: A retrospective chart review was performed to obtain 2 years of follow-up data of DSAEK or PK at a single center from March 2009 to September 2012. The study comprised 15 eyes of DSAEK and 11 eyes of PK. Outcome measures included best-corrected visual acuity (BCVA), spherical and keratometric changes, central corneal thickness, endothelial cell density, intraocular pressure, and postoperative complications. Graft survival rate was assessed by Kaplan-Meier survival analysis. RESULTS: There were no differences in patient baseline characteristics between the two groups. At postoperative 2 years, better BCVA of 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR) was found after DSAEK compared to 0.88 ± 0.48 logMAR after PK. Refractive cylinder in DSAEK and PK was -2.60 ± 1.53 and -6.00 ± 1.05 diopters (D), respectively, and keratometric cylinder was 3.27 ± 3.70 and 6.34 ± 3.51 D, respectively, at postoperative 2 years. The difference of mean spherical equivalents between postoperative 1 month and 2 years was 0.84 D after DSAEK and 2.05 D after PK. A hyperopic shift of 1.17 D was present after 2 years of DSAEK. The mean endothelial cell density at postoperative 2 years was 1,548 ± 456 cells/mm2 for DSAEK and 1,052 ± 567 cells/mm2 for PK, with a cell loss of 19.96% vs. 52.38%, respectively when compared to postoperative 1 month. No significant difference in central corneal thickness was found between DSAEK and PK (592 ± 75 vs. 563 ± 90 µm, respectively). Finally, the 2-year survival rate did not differ significantly between DSAEK and PK (93.3% vs. 81.8%, respectively, p = 0.344). CONCLUSIONS: Compared to PK, DSAEK provided more stable refractive errors with better visual outcome, lower endothelial cell loss, and a lower rate of graft rejection at postoperative 2 years in patients with bullous keratopathy.

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia.

PURPOSE: High myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery. METHODS: We included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery. RESULTS: The study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Moderately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.

Efficacy and Safety of Carbomer-Based Lipid-Containing Artificial Tear Formulations in Patients With Dry Eye Syndrome.

PURPOSE: To evaluate the efficacy and safety profile of carbomer-based lipid-containing artificial tear formulations (CBLAT) in patients with dry eye syndrome. METHODS: A multicenter parallel-group study was conducted in 412 patients with dry eye syndrome. Of these patients, 221 switched from using artificial tears to CBLAT (switching group) and 191 added CBLAT to their current treatment (add-on group). Ocular symptom scores, ocular staining grades, tear film breakup time (tBUT), Schirmer I test value, and Korean dry eye level (as defined by the Korean Corneal Disease Study Group guidelines) were evaluated at baseline and after 4 weeks of treatment. RESULTS: After 4 weeks of treatment, ocular surface staining grade, tBUT, Schirmer I value, ocular irritation symptom scores, and the positive rate of visual symptom improved significantly in both groups. Mean reductions in ocular surface staining grades (-0.8 ± 0.9) and ocular irritation symptom scores (-0.8 ± 0.8) in the add-on group were significantly higher than those (-0.5 ± 0.8 and -0.6 ± 0.8) in the switching group (P < 0.01 and P < 0.05). The positive rate of visual symptoms (44.2%) in the add-on group was significantly higher than that (26.4%) in the switching group (P < 0.01). The decrease of Korean dry eye level was 30.1% in the switching group and 51.6% in the add-on group. More patients in the add-on group had decreased dry eye levels than those in the switching group (P < 0.0001). CONCLUSIONS: CBLAT improves ocular surface staining grades, tBUT, Schirmer I values, and ocular symptoms in patients with dry eye syndrome.

Diquafosol promotes corneal epithelial healing via intracellular calcium-mediated ERK activation.

Diquafosol is known as a purinergic P2Y2 receptor (P2Y2R) agonist that stimulates water and mucin secretion from conjunctival epithelial cells and goblet cells, leading to tear film stability in dry eye. However, its effect on corneal epithelial healing has not yet been elucidated. The aim of the present study was to evaluate the effect of diquafosol on corneal epithelial healing in vivo and on P2Y2R-related downstream signaling pathways in vitro. We administered 3% diquafosol ophthalmic solution on 3 mm-diameter epithelial defects made in rat corneas and assessed the wound closure over time. Corneal epithelial healing was significantly accelerated in diquafosol-treated eyes compared to control eyes at 12 and 24 h. During wound healing, P2Y2R staining appeared stronger in the re-epithelized margin near the wound defect. To evaluate whether diquafosol stimulates epidermal growth factor receptor/extracellular-signal-regulated kinase (EGFR/ERK)-related cell proliferation and migration, simian virus 40-transfected human corneal epithelial (THCE) cells were used for in vitro experiments. Cell proliferation was accelerated by diquafosol at concentrations from 20 to 200 µM during 48 h, but inhibited at concentrations over 2000 µM. The intracellular calcium ([Ca(2+)]i) elevation was measured in diquafosol (100 µM)-stimulated cells using Fluo-4/AM ([Ca(2+)]i indicator). [Ca(2+)]i elevation was observed in diquafosol-stimulated cells regardless of the presence of calcium in media, and suramin pretreatment inhibited the calcium response. The effect of diquafosol on phosphorylation of EGFR, ERK and Akt, and cell migration was determined by western blotting and in vitro cell migration assay. Diquafosol induced phosphorylation of EGFR at 2 min post-stimulation, and phosphorylation of ERK at 5 min post-stimulation. Phosphorylation of ERK was attenuated in cells pretreated with suramin or BAPTA/AM ([Ca(2+)]i chelator), and partially with AG1478 (EGFR inhibitor). Likewise, diquafosol-treated cells showed acceleration of gap closure in cell migration assay, which was inhibited by suramin, BAPTA/AM, AG1478, and U0126 (MEK inhibitor). These studies demonstrate that diquafosol is effective in promoting corneal epithelial wound healing and that this effect may result from ERK-stimulated cell proliferation and migration via P2Y2R-mediated [Ca(2+)]i elevation.

Serologic Markers Are Associated With Ocular Staining Score in Primary Sjögren Syndrome.

PURPOSE: To investigate the relationship between serologic markers and dry eye severity in subjects with primary Sjögren syndrome (SS). METHODS: This study evaluated 64 patients diagnosed with primary SS according to the 2012 Sjögren's International Collaborative Clinical Alliance (SICCA) classification criteria. Serum anti-Ro/SSA, anti-La/SSB, rheumatoid factor (RF), and antinuclear antibody (ANA) levels, Ocular Surface Disease Index (OSDI), Schirmer I test values, tear film breakup time, and SICCA ocular staining score (OSS) were determined. RESULTS: The conjunctival staining scores were 3.3 ± 1.9, 3.6 ± 2.0, 3.4 ± 1.9, and 3.5 ± 1.9 in the positive anti-Ro (≥25 EU), positive anti-La (≥25 EU), positive RF (≥20 IU/mL), and positive ANA (≥1:320) group, respectively. Subjects with positive anti-Ro, anti-La, RF, or ANA had significantly higher conjunctival staining scores compared with those with negative levels (P < 0.05). The total OSS in the positive ANA group was 5.5 ± 3.0, which was significantly higher than the total OSS (3.4 ± 2.1) in the negative ANA group (P = 0.005). Serum RF and ANA levels had strong correlations with conjunctival staining scores and the total OSS but not with corneal staining scores (r = 0.53, P < 0.001 and r = 0.382, P = 0.002). Other ocular parameters (OSDI, Schirmer I test values, and tear film breakup time) did not differ by the serologic marker level. Interestingly, the OSDI was positively correlated with the corneal staining score and total OSS (r = 0.646, P < 0.001 and r = 0.476, P < 0.001). CONCLUSIONS: Serum RF and ANA levels are associated with conjunctival staining scores and the total OSS according to the SICCA OSS in primary SS.

Association of IL-21 cytokine with severity of primary Sjögren syndrome dry eye.

PURPOSE: IL-21 plays an important role in primary Sjögren syndrome (SS) pathogenesis. The purpose of this study was to evaluate IL-21 expression in tears and the conjunctiva and to analyze the impact of IL-21 on primary SS dry eyes. METHODS: Eighty subjects were enrolled in this study: 30 patients with primary SS dry eye (30 eyes); 30 patients with non-SS dry eye (30 eyes), and 20 normal controls. Tear IL-21 levels were measured by flow cytometry, and IL-21 gene expression in the conjunctiva from impression cytology was evaluated by quantitative polymerase chain reaction. Ocular Surface Disease Index, tear film breakup time, Schirmer I test, and ocular surface staining scores were obtained for all patients. RESULTS: Primary SS dry eyes had significantly higher tear IL-21 levels than non-SS dry eyes and normal controls (P < 0.01). In addition, IL-21 gene expression in the conjunctiva was also higher in primary SS dry eyes than in non-SS dry eyes and normal controls (P < 0.01). However, there were no significant differences in IL-21 expression in tears and the conjunctiva between non-SS dry eyes and controls. The tear IL-21 level was significantly correlated with ocular surface stain scores (r = 0.54, P < 0.01) and Schirmer I test values (r = -0.23, P < 0.05) in primary SS dry eyes. CONCLUSIONS: Our findings suggest that severity of primary SS dry eye is associated with IL-21.

Expression of p53 and caspase-8 in lens epithelial cells of diabetic cataract.

PURPOSE: To determine expression of apoptotic factors p53 and caspase-8 in human lens epithelial cells (LECs) of cataract patients with or without diabetic retinopathy (DR), the duration of diabetes mellitus (DM), and the level of glycated hemoglobin (hemoglobin A1c [HbA1c]). SETTING: St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea. DESIGN: Randomized prospective study. METHODS: The LECs were isolated during cataract surgery. The isolated samples were classified into 4 groups as follows: patients without DM (Group 1), patients with DM but not DR (Group 2), diabetic patients with nonproliferative DR (Group 3), and diabetic patients with proliferative DR (Group 4). To explore the mechanism of apoptosis, the expressions of p53 and caspase-8 were measured by immunohistochemical staining and compared with the data according to the duration of DM, HbA1c levels, and severity of DR. RESULTS: All groups comprised 15 eyes. The expressions of P53 and caspase-8 were higher in Groups 2, 3, and 4 than in Group 1 (P<.001). The expressions were statistically significantly increased with a longer duration of DM, higher HbA1c levels, and advanced DR. CONCLUSIONS: The expressions of P53 and caspase-8 were strong in patients with DM and advanced DR. Knowledge of these relationships may lead to a better understanding of the development of diabetic cataract. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Objective assessment of nuclear cataract: comparison of double-pass and Scheimpflug systems.

PURPOSE: To compare the objective assessment of lens density by 2 systems (double-pass Optical Quality Analysis System and Pentacam Scheimpflug) in eyes with age-related nuclear cataract. SETTING: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. DESIGN: Cross-sectional study. METHODS: In eyes with age-related nuclear cataract, the objective lens density (0 to 100 points) was determined using the Scheimpflug system while subjective grading was achieved using the Lens Opacities Classification System III (LOCS III). The objective scatter index (OSI) (0 to 25) was assessed using the double-pass system. RESULTS: This study enrolled 47 patients (70 eyes). The mean OSI was 4.08 ± 2.22 (SD), and the mean Scheimpflug-measured lens density was 16.44 ± 4.36; the 2 parameters were correlated (r = 0.764, P<.01). There was a positive linear correlation between the OSI and LOCS III grading scores for nuclear opalescence and nuclear color (r = 0.772 and r = 0.752, respectively; P<.01). The cumulated dissipated energy (CDE) was strongly correlated with the OSI (r = 0.768) and Scheimpflug-measured lens density (r = 0.753). CONCLUSIONS: The OSI based on the double-pass system was correlated with the Scheimpflug-measured lens density, subjective lens grading, and CDE. The OSI may improve the preoperative evaluation of nuclear cataract and help predict phacodynamics in cataract surgery.

Risk factors for decompression retinopathy after glaucoma surgery.

PURPOSE: To evaluate the risk factors for decompression retinopathy after glaucoma surgery. METHODS: We reviewed the medical records of patients who underwent a trabeculectomy or Ahmed valve implantation and divided them into 2 groups by the development of decompression retinopathy. Various factors were compared between the 2 groups, including age, sex, glaucoma type, previous intraocular surgery, preoperative and postoperative intraocular pressure (IOP), refractive error, axial length, anesthesia, and systemic risk factors such as history of diabetes, hypertension, medication, and a laboratory examination including hemoglobin, hematocrit, platelet, prothrombin time (PT), and activated partial thromboplastin time (aPTT). RESULTS: The proportion of eyes with decompression retinopathy was 3.05% (21 of 688 eyes), and 50 control eyes were selected randomly. No significant differences were observed between the 2 groups in age, systemic disease, glaucoma type, anesthesia, or the incidence rate of postoperative hypotony. Preoperative maximum IOP and the change of IOP was higher (P=0.016, 0.019), PT and aPTT was prolonged (P=0.001, 0.006), and hemoglobin and hematocrit level was lower in patients with decompression retinopathy (P=0.005, 0.002). Preoperative maximum IOP and hemoglobin showed a significant association with the development of decompression retinopathy in a multivariate analysis (P=0.031, 0.040). No significant difference was observed between the 2 groups for IOP and visual acuity 6 months postoperatively. CONCLUSIONS: Patients with high preoperative IOP and hematologic abnormalities have a higher risk for developing decompression retinopathy. Surgeons should carefully assess the potential risks and pay close attention to sufficiently decrease IOP preoperatively.

Niflumic acid reduces histamine-induced interleukin-6 and -8 expression in human conjunctival epithelial cells.

BACKGROUND/AIMS: Histamine remains the main mediator of allergic conjunctivitis and induces interleukin (IL)-6 and IL-8 production in human conjunctival epithelial cells (HCEC). The purpose of the present study was to determine whether histamine induced IL-6 and IL-8 expression in HCEC, and to describe the relationship between human calcium-activated chloride channel (hCLCA) 1 activity and IL-6 and IL-8 expression. METHODS: HCEC were isolated from human conjunctiva and cultured at an air-liquid interface. IL-6 and IL-8 mRNA expression was examined by real-time PCR, and IL-6 and IL-8 secretion was measured by ELISA after stimulation of HCEC with histamine. RESULTS: Histamine upregulated IL-6 and IL-8 expression and IL-6 and IL-8 secretion in a dose-dependent manner in HCEC. Niflumic acid (NFA), an hCLCA blocker, reduced histamine-induced IL-6 and IL-8 expression. CONCLUSION: Histamine-induced IL-6 and IL-8 production could be attenuated by NFA, an hCLCA blocker.

Visualization of blebs using anterior-segment optical coherence tomography after glaucoma drainage implant surgery.

OBJECTIVE: The current study investigated the internal structure of blebs using anterior-segment optical coherence tomography (AS-OCT) in patients who had undergone Ahmed glaucoma valve (AGV) (New World Medical Inc, Rancho Cucamonga, CA) implantation and compared the differences between successful and failed surgeries. DESIGN: Cross-sectional, observational study. PARTICIPANTS: A total of 76 patients who had undergone AGV implantation. METHODS: The blebs after AGV implantation were examined using AS-OCT. The relationship between intraocular pressure (IOP) or the number of glaucoma medications and intrableb parameters was evaluated. Success was defined as IOP ≤ 21 mmHg with a maximum of 2 glaucoma medications, and the remaining cases were assigned to the "failed surgery group." Logistic regression was used to determine the predictive value of various bleb parameters measured by AS-OCT for bleb success. MAIN OUTCOME MEASURES: The bleb wall thickness (minimum and maximum) and the reflectivity of the bleb wall (mean, modal value, minimum, and maximum). RESULTS: Blebs from 46 successful (60.5%) and 30 failed (39.5%) AGV implantation surgeries were analyzed. The AS-OCT imaging of the intrableb configuration revealed a relatively regular surface and a homogeneous and hyperreflective bleb wall. The maximum and minimum bleb wall thicknesses were significantly different between the 2 groups (P<0.001, P<0.005). No significant differences were observed between the 2 groups in mean, modal, maximum, or minimum reflectivity of the bleb wall. The maximum and minimum bleb wall thicknesses were significantly correlated with the postoperative maximum IOP (r = 0.402, P<0.001; r = 0.280, P = 0.014). The maximum and minimum bleb wall thicknesses showed a significant correlation with the number of postoperative glaucoma eye drops (r = 0.452, P<0.001; r = 0.327, P = 0.004). Maximum bleb wall thickness was significantly associated with the success of AGV surgery by multivariate analysis (P<0.001). CONCLUSIONS: Anterior-segment OCT can be used for bleb imaging after glaucoma valve implantation. The AS-OCT results revealed that the maximum bleb wall was significantly thinner in successful AGV implant surgeries compared with unsuccessful AGV implant surgeries. This technique may facilitate the investigation of surgical outcomes and pathogenesis in patients receiving glaucoma valve implants. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.