title: Collagen Cross-linking for Late-onset Bleb Leakage: 1-Year Results.
abstract: OBJECTIVE
  To assess the efficacy of collagen cross-linking in the treatment of late-onset bleb leakage.
  
  
  METHODS
  A retrospective, interventional case-series. Cross-linking was performed for late-onset bleb leakage after failure of standard medical therapy. Primary outcome is measured by complete resolution of bleb leakage. Secondary outcomes including intraocular pressure and corrected distance visual acuity (CDVA) were documented over 1 year and were analyzed using repeated measure ANOVA.
  
  
  RESULTS
  Seven patients underwent cross-linking for bleb leakage between 2012 and 2013. Five (71%) had complete resolution of bleb leakage. Intraocular pressure improved from 3.9±1.0 to 7.4±1.1 mm Hg at 1 to 2 months (P=0.0003) and remained at 9.6±3.0 mm Hg at final visit (P=0.06). The corresponding CDVA also improved from 0.6±0.2 to 0.38±0.37 logMAR (P=0.0069) at 1 to 2 months before stabilizing at 0.38±0.44 (P=0.0021) at 1 year. Two cases (29%) had persistent bleb leakage after treatment. Four patients (57%) had resolved hypotony (≥6 mm Hg) at final visit. No adverse event was reported.
  
  
  CONCLUSIONS
  Collagen cross-linking is a noninvasive treatment offering reasonable success rate for filtering bleb leakage, and may spare patients invasive surgical bleb revisions.
authors.affiliation: *Department of Ophthalmology, University of Montreal †Montreal Glaucoma Institute, Montreal, QC, Canada.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Harasymowycz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003094:Collagen / Q000378:metabolism*; D003228:Conjunctiva / Q000378:metabolism; D003229:Conjunctival Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D003432:Cross-Linking Reagents; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000009:adverse effects*; D014466:Ultraviolet Rays; D014792:Visual Acuity
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin