title: Collagen crosslinking in the management of leaking cystic blebs: a prospective study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China. bonniechoynk@gmail.com.
authors.forename: Bonnie Nga Kwan
authors.initials: BN
authors.lastname: Choy
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China.
authors.forename: Ming Ming
authors.initials: MM
authors.lastname: Zhu
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China.
authors.forename: Jennifer Wei Huen
authors.initials: JW
authors.lastname: Shum
authors.affiliation: Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, China.
authors.forename: Wing Lau
authors.initials: WL
authors.lastname: Ho
authors.affiliation: Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, China.
authors.forename: Jonathan Cheuk Hung
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China.
authors.forename: Alex Lap Ki
authors.initials: AL
authors.lastname: Ng
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, SAR, China.
authors.forename: Jimmy Shiu Ming
authors.initials: JS
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003094:Collagen / Q000378:metabolism*; D003228:Conjunctiva / Q000378:metabolism*; D003432:Cross-Linking Reagents; D005260:Female; D005902:Glaucoma, Open-Angle / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D013529:Surgical Wound Dehiscence / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin
keywords: Bleb leak; Collagen crosslinking; Conjunctival leak; Cystic bleb