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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin ...
Journal Information
Vol. 95. Issue 2.
Pages 64-70 (February 2020)
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Vol. 95. Issue 2.
Pages 64-70 (February 2020)
Original article
DOI: 10.1016/j.oftale.2019.10.005
Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft
Manejo de la ampolla isquémica hiperfiltrante:
N. Romanic Bubaloa,
Corresponding author

Corresponding author.
, J. Loscos Arenasa, P. Romera Romeroa, A. Moll Udinab, S. Grixolli Mazzona, P. Díaz Aljaroa
a Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
b Departamento de Oftalmología, Institut Clínic d’Oftalmologia, Hospital Clínic y Provincial de Barcelona, Barcelona, Spain
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Tables (3)
Table 1. Demographic data of the 3 groups comprising age, sex, previous surgery, use of metabolite and previous lens condition.
Table 2. Endothelial count analysis and morphological analysis of filtration blebs prior to cross-linking with riboflavin and at 12 months after treatment.
Table 3. Data summary per group, visual acuity before procedure and 12 months later, medication before procedure and 12 months later and previous and 12-month intraocular pressure.
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To compare and evaluate the safety and clinical results of three techniques for the management of hyperfiltrating ischemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival auto transplantation.

Material and methods

A total of 24 eyes were selected from 18 patients with ischemic blebs underwent filtering glaucoma surgery between 2012 and 2017 and underwent crosslinking using riboflavin (n=4), conjunctival auto transplant (n=5) and conjunctival slip (n=15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months are compared, as well as visual acuity (VA) and prior antiglaucomatous medication and at 12 months.


Four eyes underwent CXL, from an average previous IOP of 12,11±3,14 to an IOP of 12,32±5,29 at one year (p=0,655). Five eyes were treated by conjunctival autologous graft, the previous IOP being average of 11,65±5,76 and the IOP at one year of 14,68±7,21 (p=0,273). Fifteen eyes subjected to conjunctival slipping presented a previous IOP of 9,32±5,34 and a year of 15,16±9,24 (p=0,021). There were no adverse effects or complications associated with any of the three techniques.


The management of the hyperfiltrating ischemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalization of the bleb.

Collagen crosslinking
Ischemic bleb
Conjunctival sliding
Conjunctival autologous graft

Comparar y evaluar la seguridad y resultados clínicos de tres técnicas para el manejo de las ampollas isquémicas hiperfiltrantes en glaucoma, como el crosslinking con riboflavina (CXL) respecto al deslizamiento y el autotrasplante conjuntival.

Material y métodos

Se seleccionan un total de 24 ojos de 18 pacientes con ampollas isquémicas intervenidos de cirugía filtrante de glaucoma entre 2012–2017 y se les somete a CXL mediante el uso de riboflavina (n=4), autotrasplante conjuntival (n=5) y deslizamiento conjuntival (n=15). Se comparan los resultados de la presión intraocular (PIO) previa al procedimiento y a los 12 meses, así como agudeza visual (AV) y medicación antiglaucomatosa previa y a los 12 meses.


Cuatro ojos se sometieron a CXL mediante riboflavina, pasando de una PIO media previa de 12,11±3,14 a una PIO al año de 12,32±5,29 (p=0,655). Cinco ojos fueron tratados mediante autotrasplante de conjuntiva, siendo la PIO previa media de 11,65±5,76 y la PIO al año de 14,68±7,21 (p=0,273). Quince ojos sometidos a deslizamiento conjuntival presentaban una PIO previa de 9,32±5,34 y al año de 15,16±9,24 (p=0,021). No acontecieron efectos adversos ni complicaciones asociadas a ninguna de las tres técnicas.


El manejo de la ampolla isquémica hiperfiltrante resulta difícil. Los procedimientos quirúrgicos se asocian a incrementos tensionales y necesidad de medicación, mientras que el CXL mediante el uso de riboflavina y radiación UV no parece tener un efecto sobre la revitalización de la ampolla.

Palabras clave:
Crosslinking ampolla conjuntival
Ampolla isquémica
Deslizamiento conjuntival
Autotrasplante conjuntival


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