Abstract
Purpose :
Case reports and series describe post-selective laser trabeculoplasty (SLT) central corneal edema, with subsequent thinning and hyperopic shift, which can permanently affect vision. This study tested the hypothesis that the incidences of these findings post-SLT are low in the United States.
Methods :
This is a 16-year retrospective population-based study of glaucoma patients >18 years using a de-identified database of administrative health claims for patients of a large national managed care company affiliated with Optum, the Clinformatics® Data Mart (CDM). Included for analysis were patients’ first SLT with one year of continuous enrollment pre-SLT without prior corneal pathology including edema, ectasia, keratomalacia, recurrent erosions, endothelial dystrophy, herpes simplex and varicella zoster viral keratitis, corneal transplant and complications, corneal scars and other disorders of cornea. The primary outcome was corneal edema in at least one eye within 30 days post-SLT and secondary outcomes were keratomalacia, ectasia or other specified disorders of cornea in at least one eye within 120 days post-SLT.
Results :
From the CDM’s medical claims and medical procedures tables, 86,634 patients had undergone SLT in at least one eye. After exclusion of prior corneal pathology, 83,253 remained. The baseline characteristics of this cohort revealed 9,472(11%) had myopia, 3,718(4%) hyperopia, 1,518(2%) irregular astigmatism, 55,002(66%) primary open angle glaucoma, 10,765(13%) ocular hypertension, 5,010(6%) normal tension glaucoma, 2,452(3%) pseudoexfoliative glaucoma, 1,790(2%) pseudoexfoliation syndrome, 1,775(2%) pigmentary glaucoma, 1,409(2%) pigment dispersion syndrome, 1,755(2%) chronic angle closure glaucoma, 498(<1%) steroid response, and 310(<1%) uveitic glaucoma. 36 were found to have corneal edema within 30 days post-SLT, and 21 with keratomalacia, ectasia or other specified disorders of cornea within 120 days post-SLT. None overlapped. The overall incidence of both primary and secondary outcomes in patients without previous corneal pathology was 0.07%.
Conclusions :
New corneal edema, keratomalacia, ectasia was found post-SLT at a low rate in a cohort with diverse glaucoma diagnoses. Laterality cannot be determined within the dataset, thus the rate may be even lower. Future studies may reveal risk factors among the baseline characteristics.
This is a 2021 ARVO Annual Meeting abstract.