CORNEAL OPACITIES FOLLOWING SELECTIVE LASER TRABECULOPLASTY

Selective Laser Trabeculoplasty (SLT) is a laser treatment option for the reduction of intraocular pressure (IOP) in glaucoma patients.  Complications, such as uveitis and IOP spikes, are rare and often transient.  Adverse events involving the cornea are scarcely reported in the current literature. 

Eye Care Centre, Leighton Hospital, United Kingdom.

Retrospective review of case from Medisight electronic patient record and image suite.

81-year-old patient who underwent bilateral SLT (Tango^TM Ellex laser machine) for primary open angle glaucoma on 13^th May 2022; IOPs were 18 (right) and 20 (left).  The only ocular comorbidity was a right eye nuclear cataract (left pseudophakic); the cornea was clear in all previous examinations.  Each eye received 360° coverage with 80 x 400µm shots, 0.7mJ per pulse (5^th session right eye and 6^th session left eye total).  On 3-month follow-up, the patient reported deterioration in vision.  Visual acuity pre-treatment was 6/9 unaided in both eyes and was stable following SLT.  IOPs were successfully reduced to 10 (right) and 12 (left).  However, on examination, there was central corneal opacities in both eyes.  Cornea clinic follow-up concluded that these opacities likely represented crocodile shagreen, a degenerative disorder of the cornea.

This case reports the occurrence of a potential corneal complication post-SLT treatment, which is not reported within the current literature base.  With its increased used in early glaucoma, it is important to understand all potential risks of SLT so that both the clinician and patient can make safe and informed management decisions.