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Mausam R Damani, Marlene R Moster, Meredith Regina, Stephen Orlin; Selective Laser Trabeculoplasty (SLT) Induced Changes in Refractive Error and Corneal Structure. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6121.
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To retrospectively explore the incidence and nature of corneal complications from the use of selective laser trabeculoplasty. The use of laser trabeculoplasty more than doubled according to Medicare data from 2001 to 2004, a trend partially attributed to the introduction of selective laser trabeculoplasty (SLT) in 2001. Since its advent SLT has become widely used for the treatment of open-angle glaucoma, preferred over older modalities such as Argon laser trabeculoplasty (ALT) due to its favorable safety profile. One should be aware, however, of emerging data on refractive changes and corneal complications arising after SLT.
Retrospective analysis of all patients in our clinical database undergoing selective laser trabeculoplasty (SLT) from 2002 until the present.
From a retrospective analysis of our patient database from 2002 until the present, we found 4 cases of refractive and corneal changes occurring after SLT treatment. All four patients presented after SLT with substantial acute decrease in best corrected visual acuity (BCVA), to as low as 20/200 in the worst case Exam revealed central corneal haze, thinning and dramatic topographic flattening, along with varying degrees of hyperopic shift, the greatest of which was 8.75D. At 6 months or longer BCVA had improved to at least 20/30 in all patients, however, central corneal thinning persisted (Table 1 and Table 2).
While SLT is generally thought to be safe and the incidence of complications is low, significant refractive shift and corneal changes can occur. The underlying mechanism may be due to endothelial damage from SLT-induced inflammation, corneal epithelial toxicity from the coupling agent used in the procedure, and/or laser energy misdirection. Given the large number of SLT procedures performed, further studies investigating the etiology and predisposing factors for these changes are needed.
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