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, 3 months, 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 (92%) of 12 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 = .71, P = .014). Bleb wall at 3 months was significantly thicker than at baseline (0.70 ± 0.67 vs 0.81 ± 0.62 mm, P = .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.