Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva / Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft

INTRODUCCIÓN: En este estudio se com:para y evalúa la seguridad y los resultados clínicos de 3 técnicas para el manejo de las ampollas isquémicas hiperfiltrantes en glaucoma: el crosslinking con riboflavina (CXL) respecto al deslizamiento y el autotrasplante conjuntival. MÉTODOS: Se seleccionaron un total de 24 ojos de 18 pacientes con ampollas isquémicas intervenidos de cirugía filtrante de glaucoma entre 2012 y 2017. Fueron intervenidos de 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 de la agudeza visual y de la medicación antiglaucomatosa previa y a los 12 meses. RESULTADOS: Los 4 de la riboflavina pasaron de una PIO media previa de 12,11 ± 3,14 a una PIO al año de 12,32 ± 5,29 (p = 0,655). Los 5 ojos del autotrasplante de conjuntiva tuvieron una PIO previa media de 11,65 ± 5,76 y al año de 14,68 ± 7,21 (p = 0,273). Los 15 ojos tratados mediante deslizamiento conjuntival presentaron una PIO previa de 9,32 ± 5,34 y al año de 15,16 ± 9,24 (p = 0,021). No hubo efectos adversos ni complicaciones asociadas a ninguna de las 3 técnicas. CONCLUSIONES: El manejo de la ampolla isquémica hiperfiltrante resulta difícil. Los procedimientos quirúrgicos se asocian a incrementos tensionales y a 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

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3 techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n = 4), conjunctival autologous graft (n = 5), and conjunctival sliding (n = 15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4 eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P = .655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P = .273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P =. 021). There were no adverse effects or complications associated with any of the 3 techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic 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 revitalisation of the bleb

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: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva.

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n=4), conjunctival autologous graft (n=5), and conjunctival sliding (n=15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P=.655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P=.273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P=.021). There were no adverse effects or complications associated with any of the 3techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic 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 revitalisation of the bleb.