Prospective study on a novel treatment for leaking cystic bleb: efficacy and safety of collagen crosslinking.

IMPORTANCE: Management of cystic bleb leak is difficult. It would be essential to look for a method to strengthen the original pathological conjunctiva and reverse bleb leak.

BACKGROUND: To evaluate the long-term efficacy and safety of collagen crosslinking in patients with leaking cystic bleb.

DESIGN: Prospective interventional case series at a university-based hospital.

PARTICIPANTS: Twelve eyes in 12 subjects with late onset bleb leak from cystic bleb, without indications for prompt surgical interventions were included.

METHODS: The subjects underwent crosslinking with 0.1% riboflavin application to bleb surface, followed by ultraviolet irradiation for 30 minutes. The subjects were followed up at baseline and at 1 week, 1 month, 3months, 6 months post treatment, and then every 6 months afterwards.

MAIN OUTCOME MEASURES: Interval from treatment to cessation of bleb leak, recurrence rate of bleb leak, and side effects of treatment.

RESULTS: The mean follow-up after crosslinking was 29.33±12.45 months. Bleb leak subsided in 11/12 (92%) patients after a single session of crosslinking, after 1 to 8 weeks (median 3 weeks). Time to leak cessation was significantly correlated with the number of prior glaucoma interventions (R=0.71，P=0.014). Bleb wall at 3 months was significantly thicker than at baseline (0.70±0.67 vs. 0.81±0.62 mm, P=0.008). None of the patients experienced any complications.

CONCLUSIONS AND RELEVANCE: Crosslinking achieves resolution of cystic bleb leak which lasts for at least 12 months, without the need of subsequent surgical interventions. Crosslinking is a simple, non-invasive treatment for bleb leak. It aims to restore the integrity of conjunctiva. This article is protected by copyright. All rights reserved.