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Collagen crosslinking in the management of leaking cystic blebs: a prospective study

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effectiveness and safety of collagen crosslinking for leaking cystic blebs.

Methods

A prospective study was conducted on subjects with cystic bleb leaks without indications for urgent surgical intervention. Collagen crosslinking with riboflavin 0.1 % and ultraviolet A irradiation for 30 min was applied to the cystic bleb surface in five patients. Subjects were followed up for at least 20 weeks (mean: 35.5 ± 11.5 weeks) to monitor the length of time to the cessation of bleb leak, as well as visual acuity, intraocular pressure, and the presence of adverse effects arising from the treatment.

Results

Results showed that a single session of collagen crosslinking was effective in stopping cystic bleb leak. In two of the five subjects, the bleb leak subsided 1 week post-treatment, in one patient after 2 weeks, and in the two more complicated cases, after 4 weeks. This effect was maintained for a mean period of 33.5 ± 10.2 weeks after bleb leak cessation. Treatment was effective even in patients with friable conjunctiva following multiple surgical interventions and severe leak, although a longer period was needed for resolution of the bleb leak. The intraocular pressure and visual acuity were largely stable before and after treatment. No side effects or complications arose from this treatment.

Conclusions

We recommend a trial of collagen crosslinking on leaking cystic blebs without indications for immediate surgical interventions. It is a relatively easy, non-invasive, pain-free, and potential repeatable procedure for treating leaking cystic blebs, with the aim of strengthening the underlying pathological conjunctiva.

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References

  1. Duke-Elder S, Ashton N (1951) Action of cortisone on tissue reactions of inflammation and repair with special reference to the eye. Br J Ophthalmol 35:695–707

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Wise JB (1993) Treatment of chronic postfiltration hypotony by intrableb injection of autologous blood. Arch Ophthalmol 111:827–830

    Article  CAS  PubMed  Google Scholar 

  3. Nuyts RMMA, Greve EL, Geijssen C et al (1994) Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C. Am J Ophthalmol 118:322–331

    Article  CAS  PubMed  Google Scholar 

  4. Smith MF, Magauran R, Doyle JW (1994) Treatment of postfiltration bleb leak by bleb injection of autologous blood. Ophthalmic Surg 25:636–637

    CAS  PubMed  Google Scholar 

  5. Flynn WJ, Rosen WJ, Campbell DG (1997) Delayed hyphema and intravitreal blood following intrableb autologous blood injection after trabeculectomy. Am J Ophthalmol 124:115–116

    Article  CAS  PubMed  Google Scholar 

  6. Asrani SG, Wilensky JT (1996) Management of bleb leaks after glaucoma filtering surgery. Use of autologous fibrin tissue glue as an alternative. Ophthalmology 103(2):294–298

    Article  CAS  PubMed  Google Scholar 

  7. Seligsohn A, Moster MR, Steinmann W, Fontanarosa J (2004) Use of Tisseel fibrin sealant to manage bleb leaks and hypotony: case series. J Glaucoma 13(3):227

    Article  PubMed  Google Scholar 

  8. Belyea DA, Dan JA, Stamper RL, Lieberman MF, Spencer WH (1997) Late onset of sequential multifocal bleb leaks after glaucoma filtration surgery with 5-fluorouracil and mitomycin C. Am J Ophthalmol 124(1):40–45

    Article  CAS  PubMed  Google Scholar 

  9. Zalta AH, Wieder RH (1991) Closure of leaking filtering blebs with cyanoacrylate tissue adhesive. Br J Ophthalmol 75(3):170–173

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Rauscher FM, Barton K, Budenz DL, Feuer WJ, Tseng SC (2007) Long-term outcomes of amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. Am J Ophthalmol 143:1052–1054

    Article  PubMed  Google Scholar 

  11. Kee C, Hwang JM (2002) Amniotic membrane graft for late-onset glaucoma filtering leaks. Am J Ophthalmol 133:834–835

    Article  PubMed  Google Scholar 

  12. Budenz DL, Barton K, Tseng SC (2000) Amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. Am J Ophthalmol 130:580–588

    Article  CAS  PubMed  Google Scholar 

  13. Choudhri SA, Herndon LW, Damji KF et al (1997) Efficacy of autologous blood injection for treating overfiltering or leaking blebs after glaucoma surgery. Am J Ophthalmol 123:554–555

    Article  CAS  PubMed  Google Scholar 

  14. Pircher N, Pachala M, Prager F et al (2015) Changes in straylight and densitometry values after corneal collagen crosslinking. J Cataract Refract Surg 41(5):1038–1043

    Article  PubMed  Google Scholar 

  15. Spoerl E, Huhle M, Seiler T (1998) Induction of cross-links in corneal tissue. Exp Eye Res 66:97–103

    Article  CAS  PubMed  Google Scholar 

  16. Sedaghat M, Bagheri M, Ghavami S, Bamdad S (2015) Changes in corneal topography and biomechanical properties after collagen cross linking for keratoconus: 1-year results. Middle East Afr J Ophthalmol 22:212–219

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hirji N, Sykakis E, Lam FC, Petrarca R, Hamada S, Lake D (2015) Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement. Eye (Lond) 29:764–768

    Article  CAS  Google Scholar 

  18. Hafezi F, Kanellopoulos J, Wiltfang R, Seiler T (2007) Corneal collagen crosslinking with riboflavin and ultraviolet A to treat induced keratectasia after laser in situ keratomileusis. J Cataract Refract Surg 33:2035–2040

    Article  PubMed  Google Scholar 

  19. Sloot F, Soeters N, Van der Valk R, Tahzib NG (2013) Effective corneal collagen crosslinking in advanced cases of progressive keratoconus. J Cataract Refract Surg 39:1141–1145

    Article  PubMed  Google Scholar 

  20. Wang Q, Harasymowycz P (2015) Collagen cross-linking for late-onset bleb leakage: 1-year results. J Glaucoma. doi:10.1097/IJG.0000000000000295

    Google Scholar 

  21. Wollensak G, Mazzotta C, Kalinski T, Sel S (2011) Limbal and conjunctival epithelium after corneal cross-linking using riboflavin and UVA. Cornea 30(12):1448–1454

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China

    Bonnie Nga Kwan Choy, Ming Ming Zhu, Jennifer Wei Huen Shum, Alex Lap Ki Ng & Jimmy Shiu Ming Lai

  2. Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, China

    Wing Lau Ho & Jonathan Cheuk Hung Chan

Authors
  1. Bonnie Nga Kwan Choy
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  2. Ming Ming Zhu
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  3. Jennifer Wei Huen Shum
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  4. Wing Lau Ho
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  5. Jonathan Cheuk Hung Chan
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  6. Alex Lap Ki Ng
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  7. Jimmy Shiu Ming Lai
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Corresponding author

Correspondence to Bonnie Nga Kwan Choy.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Choy, B.N.K., Zhu, M.M., Shum, J.W.H. et al. Collagen crosslinking in the management of leaking cystic blebs: a prospective study. Graefes Arch Clin Exp Ophthalmol 254, 529–533 (2016). https://doi.org/10.1007/s00417-015-3245-2

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  • DOI: https://doi.org/10.1007/s00417-015-3245-2

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