Conjunctival collagen crosslinking for the management of bleb leak

The purpose of this article is to evaluate the effectiveness of collagen crosslinking of filtering blebs with 0.1% riboflavin stimulated with ultraviolet A radiation in a case of a thin-walled filtering bleb with leakage following an episode of late blebitis. The time to cessation of the bleb leakage was studied, as well as the intraocular pressure, the visual acuity, and the presence of adverse effects during 4 years of follow-up after treatment. A single session of crosslinking was effective in resolving the leakage of the filtering bleb. There were no adverse effects. The intraocular pressure and the visual acuity remained stable after 4 years of follow-up. Collagen crosslinking with 0.1% riboflavin stimulated with ultraviolet A radiation may prove to be a simple, painless, non-invasive, and repeatable treatment of the leaking bleb with the aim of strengthening the collagen fibers of the conjunctiva and avoiding more invasive surgical treatments.

Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India.

Purpose: To evaluate the microbial etiology and associated risk factors among patients with blebitis following trabeculectomy. Materials and Methods: A retrospective analysis of all culture-proven blebitis was performed in patients who underwent trabeculectomy between January 2004 and December 2008. A standardized form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Swabbing of the infected bleb surface was performed for all suspected cases and further subjected to microbiological analysis. Results: A total of 23 patients with culture-proven blebitis were treated during the study period, with a mean age of 59.2 years (59.2 ± SD: 12.8; range, 30-81 years). Duration of onset was early (≤36 months) in six (26%) cases and late (> 36 months) in 17 (74%) cases with a range between 15 and 144 months (mean, 82.91 months; SD: 41.89). All 23 blebs were located superiorly and of which, 21 (91%) were microcystic avascular, 1 (4%) diffuse avascular, and 1 (4%) vascular flattened. The predominant risk factor identified was bleb leak (35%; 8 of 23) followed by thin bleb (22%; 5 of 23) and blepharitis (17%; 4 of 23). Bleb leaks (100%) were recorded only in patients with late onset (≥ 9 years) of infection (P< 0.001), while the incidence of ocular surface disease (100%) occurred early (≤3 years) (P< 0.001). Use of topical steroids was associated frequently with cases of thin blebs (80%; 4 of 5) (P< 0.001), while topical antibiotics showed bleb leaks (88%; 7 of 8) (P< 0.001). Coagulase-positive staphylococci were frequently recovered from blebitis with thin blebs (71%; 5 of 7) (P = 0.001), Coagulase-negative staphylococci (CoNS) with bleb leak (100%; 8 of 8) (P< 0.001), Corynebacterium with blepharitis (100%; 3 of 3) (P = 0.001), and Streptococci with releasable sutures (75%; 3 of 4) (P = 0.001). Conclusion Bleb leak is the principal risk factor responsible for late-onset blebitis, while early-onset blebitis could be ascribed to ocular surface diseases. Streptococci were mainly responsible for early onset of infection, while the late onset was due to CoNS.

Fibrin glue for sealing early bleb leak :a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 63-year-old male presented with sudden diminution of vision, eye discomfort, redness and watering in his left eye. He had undergone glaucoma valve filtering surgery for refractive secondary glaucoma one week back. He also had a history of failed augmented trabeculectomy one year earlier in the same eye. Ocular examination showed best corrected visual acuity(BCVA) of 6/18 and there was a bleb leak, shallow anterior chamber and intraocular pression(IOP) of 6mmHg. Successful sealing of bleb leak was performed using fibrin glue resulted in deepening of anterior chamber with IOP of 13mmHg. This case demonstrates that, fibrin glue is an effective method for management of early filtering bleb leak.

Analysis of Autologous Blood Injection for Late-onset Filtering Bleb Leak after Trabeculectomy

PURPOSE: To evaluate the effect of autologous blood injections for late-onset filtering bleb leakage after trabeculectomy METHODS: Retrospective chart review was done on 15 patients 16 eyes that had autologous blood injection(s) for filtering bleb leak occurring later than 2 months after trabeculectomy at the Masan Samsung Hospital. Successful treatment was defined as resolution of the bleb leak and no need for additional glaucoma medications. Failure was defined as a persistent bleb leak, intraocular pressure greater than 21 mm Hg, or the occurrence of a vision-threatening event related to the procedure. RESULTS: The mean age of the patients was 53.9 years old (38~74 years). Ten eyes were men (62.5%) and 6 were women (37.5%). Sixteen eyes of 15 patients had autologous blood injection for filtering bleb leak and were followed for a mean of 12.7 months (SD, 5.8; range, 3 to 25 months). Eleven eyes (68.7%) were classified as failures because of persistence of the leak. Five eyes (31.3%) had an initially successful outcome, but the success rate decreased over time as bleb leaks recurred in one of the five eyes at 3 month. Mean intraocular pressure increased from 4.9mmHg at pretreatment to 7.6 mmHg at final examination (P<0.05). Snellen visual acuity (with correction or pinhole) remained within 2 lines of pretreatment acuity in 12 eyes (75%). Blood seepage into the anterior chamber after autologous blood injection was the common complication, but it was transient. CONCLUSIONS: Although it showed limited success, autologous blood injection for late-onset bleb leak may be considered as a supportive measure before preforming invasive incisional surgery.

Amniotic Membrane Transplantation for Late-Onset Filtering Bleb Leaks

Successful treatment of late-onset leakage of filtering bleb often requires conjunctival advancement or conjunctival graft with the risk of bleb failure. The authors performed amniotic membrane transplantation in two patients with Seidel-positive late-onset leakage of filtering bleb. In one patient, amniotic membrane transplantation(AMT)was performed twice. In the patient who underwent AMT twice, the bleb became Seidel-negative within 5 weeks of second AMT. However, it became Seidel-positive again within next 7 weeks. In the other patient, the bleb leak was partially resolved within 4 weeks, but became exuberant again within the next 4 weeks. In our experience, AMT had only a limited benefit in treating Seidel-positive bleb leaks. However, its initial success suggests that further studies are necessary to better understand the role of amniotic membrane in bleb leak and to develop a potential therapeutic modality for treating late-onset filtering bleb leak.

Treatment of Late Bleb Leak with Human Amniotic Membrane Transplantation

Late bleb leak after trabeculectomy is a serious and intractable complication and its frequency is increasing as antimetabolites are used in the surgery. Various modalities have been challenged in the treatment of late bleb leak but the results have not been satisfactory.Amniotic membrane is avascular tissue with thick basement membrane and rich stroma, and it can modulate wound.As it does not express HLA, it doesn t induce graft rejection. With the use of these characteristics of amniotic membrane, we report a case in which late bleb leak after trabeculectomy with MMC was successfully treated with amniotic membrane transplantation maintaining bleb function.