Intraocular Pressure Spike and Corneal Decompensation Following Selective Laser Trabeculoplasty in Patients With Exfoliation Glaucoma.

Purpose

To report 5 cases of intractable intraocular pressure (IOP) elevation and 2 cases of corneal failure in patients with exfoliation glaucoma after undergoing selective laser trabeculoplasty (SLT).

Methods

SLT was performed for the treatment of exfoliation glaucoma in 5 patients, all of whom subsequently developed significant IOP elevation within 1 to 5 weeks following treatment. Two patients went on to develop corneal endothelial failure requiring transplantation within 9 to 11 months.

Results

All 5 patients failed to respond adequately to topical antiglaucoma therapy and required trabeculectomy. Two patients required secondary implantation of a glaucoma drainage device. Two patients suffered significant endothelial injury requiring corneal transplantation (one receiving penetrating keratoplasty and another receiving Descemet stripping automated endothelial keratoplasty).

Conclusions

Significant and persistent IOP spikes requiring surgical intervention following SLT are extremely rare, with only 1 other case series of 4 patients (all with heavily pigmented angles) reported in the literature. Exfoliation patients, and likely all patients with heavily pigmented angles, should be considered at higher risk for developing this complication. Corneal endothelial failure is similarly rare. Nine cases have been reported in the literature, none requiring corneal transplantation. Further clinical attention and research is needed to help elucidate what factors (both pressure-dependent and pressure-independent) may predispose patients to corneal changes following SLT.