Acute Corneal Edema With Subsequent Thinning and Hyperopic Shift After Selective Laser Trabeculoplasty

Knickelbein, Jared

Acute Corneal Edema With Subsequent Thinning and Hyperopic Shift After Selective Laser Trabeculoplasty

Monday, April 28, 2014: 2:16 PM

Room 155 (Boston Convention and Exhibition Center)

Jared Knickelbein, MD, PhD, University of Pittsburgh, Pittsburgh, PA, USA

Annapurna Singh, MD, Cleveland clinic foundation, Cleveland, OH, USA

Brian E. Flowers, MD, Ophthalmology Associates, Fort Worth, TX, USA

Unni K. Nair, MD, Ophthalmology Associates, Fort Worth, TX, USA

Joel S. Schuman, MD, University of Pittsburgh & UPMC, Pittsburgh, PA, USA

Ian P. Conner, MD, PhD, University of Pittsburgh & UPMC, UPMC Eye Center, Pittsburgh, PA, USA

Narrative Responses:

Purpose
To report four cases of acute corneal edema with subsequent thinning and hyperopic shift following selective laser trabeculoplasty (SLT) for the treatment of primary open angle glaucoma.

Methods
Retrospective case series of four patients. The right eyes of four women (ages 46, 56, 56, and 64 years) were treated with SLT for management of open angle glaucoma. Main outcome measures included patient characteristics, visual acuity, refraction, pachymetry, and slit lamp examination.

Results
All patients underwent uncomplicated SLT of the right eye. Within two days of treatment, all patients developed acute corneal edema and haze in the treated eye. Over the following weeks to months, the corneas from all treated eyes thinned to below pre-procedure thicknesses with resulting hyperopic shifts of approximately two to greater than five diopters. Of note, all patients were moderately-to-highly myopic prior to SLT (spherical equivalent: -5.00 to -13.375 D). Best-corrected visual acuity six to eight months following SLT was within two Snellen lines of pre-procedure acuity in all patients.

Conclusion
Corneal edema with subsequent corneal thinning and resultant hyperopic shift is an uncommon but likely under-recognized complication of SLT, the etiology of which remains unknown.