Partial corneal recovery following selective trabeculoplasty-induced keratopathy: Longitudinal analysis through scheimpflug imaging

Abstract

Purpose: To report an uncommon case of hyperopic shift and corneal haze, flattening and thinning following a single session of selective laser trabeculoplasty (SLT), and provide longitudinal clinical data and serial analyses of corneal profile through Scheimpflug imaging. Furthermore, a careful literature review was undertaken to determine possible risk factors for this complication.

Observations: A 47-year-old woman presented with blurred vision and mild corneal edema and haze three days following routine SLT. Ten days later, corneal edema resolved, but she was still symptomatic. Refraction exam revealed a significant hyperopic shift and high astigmatism (+4.00-6.00 x 80° versus -11.50 -0.75 x 170° at baseline). Scheimpflug imaging revealed a partial collapse of the corneal architecture, with an expressive central cornea flattening (>10 diopters) and thinning (>190μm). Over six months, refractometric and corneal parameters gradually (but not completely) returned to their pre-operative values.

Conclusions and importance: This tetrad of clinical findings - hyperopic shift, corneal haze, flattening and thinning - following SLT is referred herein by the authors as selective trabeculoplasty-induced keratopathy (STIK), which is a rare but serious complication. A critical analysis based on this case findings and on the few others reported so far suggests high-myopic patients to be more predisposed to this complication, as all reported cases had -5.0 diopters or more. Future studies are warranted to determine whether this complication can be prevented.

Keywords: Corneal complication; Keratopathy; Selective laser trabeculoplasty; Side effect.

Fig. 1

Corneal tomographic maps at different time points (A, 15 days; B, 30 days; C, 45 days; D, 3 months and E, 6 months) are displayed. Longitudinal data regarding anterior axial curvature, posterior axial curvature, posterior elevation Best Fit Toric Aspheric (BFTA) and pachymetry maps (Scheimpflug imaging) are provided.