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Acute transient corneal endothelial changes following selective laser trabeculoplasty

Authors

  • Andrew JR White FRANZCO PhD,

    Corresponding author
    1. Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge
    • NIHR Biomedical Research Centre, University of Cambridge
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  • Achyut Mukherjee MRCOphth,

    1. Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge
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  • Inderraj Hanspal MRCOphth,

    1. Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge
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  • Nicholas J Sarkies FRCOphth,

    1. Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge
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  • Keith R Martin DM FRCOphth,

    1. NIHR Biomedical Research Centre, University of Cambridge
    2. Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge
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  • Peter Shah FRCOphth

    1. NIHR BRC for Ophthalmology, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London
    2. University Hospitals Birmingham NHS Foundation Trust, Birmingham
    3. Centre for Health & Social Care Improvement, University of Wolverhampton, Wolverhampton, UK
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  • Conflict/competing interest: No stated conflict of interest.
  • Funding sources: No stated funding sources.
  • Previously presented at ARVO 2012, Fort Lauderdale USA.

Correspondence: Dr Andrew JR White, Save Sight Institute, University of Sydney, GPO Box 4337, Sydney, NSW 2001, Australia. Email: andrew.white@sydney.edu.au

Abstract

Background

To report for the first time acute transient corneal endothelial changes following selective laser trabeculoplasty.

Design

Observational case series at a tertiary referral ophthalmological centre in the United Kingdom (Addenbrooke's Hospital, Cambridge)

Participants

Ten consecutive routinely treated patients.

Methods

Baseline measurements of corneal specular microscopy, endothelial cell counts and in vivo confocal microscopy were performed prior to routine selective laser trabeculoplasty treatment. Repeat measurements were made approximately 1 h later and at a 6-week follow up.

Main Outcome Measures

Endothelial in vitro laser confocal microscopy, specular microscopic endothelial cell count, endothelial morphology, visual acuity and intraocular pressure.

Results

All patients had normal corneal endothelia prior to routine selective laser trabeculoplasty treatment, where 180 degrees of angle was treated. Approximately an hour afterwards, nearly all patients still had normal specular microscopy and cell counts (2237 ± 211 cells/mm2) but had subtle endothelial changes on slit-lamp examination. These changes were found diffusely across the cornea. The changes were not present at the 6-week follow up and cell counts remained unchanged (2278 ± 242 cells/mm2). Acuity remained unchanged throughout and the patients were not aware of these changes subjectively.

Conclusions

Selective laser trabeculoplasty appears to cause transient corneal endothelial changes in most patients that have no impact on cell count or visual acuity. Further work is required to elucidate the mechanism of this phenomenon and any long-term impact.

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