Rare Complications of Selective Laser Trabeculoplasty: Corneal Edema and Thinning in the United States Using Insurance Claims Data.

Abstract

Objective: To determine the incidence of corneal edema and thinning following selective laser trabeculoplasty (SLT) and identify associated risk factors.

Design: Population-based retrospective cohort study.

Participants: Patients who underwent SLT at 18 years of age or older were identified in Optum's deidentified Clinformatics Data Mart Database between 2003 and 2021.

Methods: Patients who underwent SLT were identified by current procedural terminology. The primary outcome was the incidence of corneal edema within 30 days or other corneal pathology within 120 days after SLT. The secondary outcome was time to first corneal complication after SLT. The demographic and clinical risk factors investigated included age, sex, race, baseline myopia, and glaucoma type.

Main outcome measures: Kaplan-Meier estimated cumulative incidence of corneal edema 30 days after or thinning 120 days after SLT. Hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.

Results: Corneal edema within 30 days or other corneal pathology within 120 days was observed in 61/82 317 (0.07%) patients who underwent SLT. The cumulative incidence of post-SLT corneal pathology was 0.07% (95% CI, 0.06%-0.09%). Post-SLT corneal pathology was more common in males (61% vs. 45%, P = 0.02); in multivariable analysis, male sex (HR, 1.85; 95% CI 1.11-3.12, P = 0.02) and myopia (HR, 1.91; 95% CI 1.02-3.61, P = 0.04) were independently associated with increased risk. Age at SLT, patient race, glaucoma type, and the use of glaucoma drops before SLT were not significantly associated with post-SLT corneal pathology after adjusting for all other covariates.

Conclusions: Our results suggest that approximately 1 in 1350 adults will develop corneal edema or thinning after SLT. Male and myopic patients undergoing SLT may be at greatest risk for developing post-SLT corneal changes.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.