Rare corneal complication following selective laser trabeculoplasty

Abstract

PurposeThis case report describes two glaucoma patients who underwent selective laser trabeculoplasty (SLT) and developed a rare post-procedure corneal complication and subsequent permanent corneal distortions and reduced acuity.ObservationsBoth patients experienced early post-procedure corneal edema, reduced visual acuity, and pain. Each patient was treated with topical steroids with resolution of the edema, but each patient had irregular corneal astigmatism which was not present pre-operatively and did not resolve.Conclusions and importanceThere are very few reported cases of post-SLT corneal edema and these typically resolve without long-term complications. The following two cases represent an uncommon adverse event of irregular corneal astigmatism despite resolution of the corneal edema. The exact mechanism of these corneal effects is not known. Practitioners should inform patients of this rare, but possible complication following SLT and consider extra precautions in patients susceptible to corneal edema.

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

“…Bettis et al reported a case series of five XFG patients with an IOP spike, two of whom developed corneal decompensation requiring keratoplasty. Several studies have shown minor transient endothelial changes after SLT, such as a reduction in endothelial cell count and central corneal thickness or an increase in dark spots in specular microscopy [ 76 , 77 , 78 , 79 , 80 , 81 ].…”

“…Other reported rare complications of SLT are hypopyon with possible herpes simplex reactivation, hyphema, cystoid macular edema in patients with diabetes, and post-ocular trauma. One case reported foveal burns resulting from the use of capsulotomy mode during SLT [ 74 , 75 , 76 , 77 , 78 , 82 , 83 , 84 , 85 , 86 ].…”

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

“…Recently, several case reports and small case series have identified a variety of potentially vision-threatening corneal complications of SLT. These include short-term reductions in endothelial cell density, 78 corneal edema (in up to 0.8% of treated eyes 79 ) complicated in some cases by irregular astigmatism, decompensation, and permanent reduction in visual acuity, [80][81][82][83][84][85] keratitis, 86,87 and corneal thinning with permanent hyperopia shifts of up to 6D. 82,84 Evidence for an SLT Dose-Response Relationship Can SLT be performed at a lower energy level and still deliver the efficacy achieved at standard energy?…”