Four articles. Four minutes. | Issue #15
Laser: Corneal edema and thinning after SLT affected 1 in 1,350 patients
Diagnostics: More frequent home visual field testing may improve progression detection despite greater test variability
Medication: Topical carbonic anhydrase inhibitors linked to higher rates of depression and anxiety
Surgery: Phaco-goniotomy remains noninferior to phaco-trabeculectomy for IOP lowering at 3 years in advanced PACG
Rare Complications of Selective Laser Trabeculoplasty: Corneal Edema and Thinning in the US Using Insurance Claims Data
Methods
This retrospective cohort study included 82,317 adults without documented prior corneal pathology who underwent SLT in the Optum Clinformatics claims database (2003 to 2021). Investigators assessed the incidence of new corneal edema within 30 days or corneal thinning, ectasia, or other corneal pathology within 120 days after SLT and identified risk factors by multivariable Cox regression.
Results
Corneal complications occurred in 61 of 82,317 patients (0.07%, 95% CI 0.06% to 0.09%), including 46 cases of corneal edema within 30 days and 15 cases of corneal thinning or other pathology within 120 days. Median onset was 20 days after SLT (IQR 12 to 28). Male sex (HR 1.85) and myopia (HR 1.91) were associated with greater risk, while age, race, glaucoma subtype, and prior glaucoma drop use were not. Despite the relative associations, the absolute risk remained very low.
Conclusion
Post-SLT corneal pathology was a rare complication, occurring in approximately 0.07% of patients in this large claims cohort. Myopia and male sex were associated with increased risk, although the claims-based design could not confirm causality or assess potentially important factors such as degree of myopia, baseline corneal thickness or endothelial health, prior refractive surgery, or SLT treatment parameters.
Our Angle
For those of us increasingly using SLT as first-line therapy, it is reassuring to find that visually significant corneal complications appear uncommon. At the same time, corneal edema followed by thinning or hyperopic shift is a real complication worth remembering when a patient reports unexpected blurred vision in the days or weeks after treatment. The median presentation at about three weeks also reminds us that this may not always be apparent at the immediate postoperative visit.
I would be cautious about changing treatment based on the reported association with male sex or myopia alone. The study could not quantify refractive error or evaluate central corneal thickness, endothelial cell count, guttae, prior refractive surgery, laser energy, spot count, or treatment extent. In a myopic patient or an eye with suspected limited endothelial reserve, these findings may justify greater awareness and a lower threshold to examine the cornea if vision changes, rather than avoiding SLT.
The next clinically relevant question is whether the complication is patient-related or technique-related. Prospective datasets such as LiGHT and COAST, and studies comparing conventional with direct SLT, could help determine whether treatment energy, extent, repeat treatments, or baseline corneal characteristics modify this risk.
Diagnostics
Fields from home: device-independent online perimetry with Melbourne Rapid Fields
Design: Cross-sectional repeated-measures agreement study
Journal: British Journal of Ophthalmology, July 2026
Authors: Montesano G et al.
Among 100 adults from the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial with stable visual fields, home visual field testing with web-based Melbourne Rapid Fields on personal computers showed greater point-wise test-retest variability and a proportional bias toward underestimating damage compared with in-clinic Humphrey 24-2 testing. Modeling suggested that 4-monthly home testing could match the progression-detection power of 6-monthly clinic perimetry, though this was based on simulated rather than observed longitudinal progression. A learning effect between the first and second home tests suggests an initial adaptation period. Most participants preferred home monitoring for convenience, but individual results were noisier, and this approach would supplement rather than replace standard clinic visits.
Medication
Depression and Anxiety After Topical Carbonic Anhydrase Inhibitors
Design: Retrospective multicenter cohort study
Journal: Ophthalmology Science, April 2026
Authors: Elhusseiny AM et al.
In a propensity-matched cohort of 8,862 pairs of glaucoma patients aged 40 and older from the TriNetX US network, topical carbonic anhydrase inhibitor (CAI) use (brinzolamide or dorzolamide, at least 4 refills) was associated with higher rates of new-onset depression (4.05% vs 2.47% at 1 year), antidepressant initiation (7.7% vs 4.4%), and anxiety disorders (3.54% vs 2.09%) compared with matched controls on other topical agents. Adjusted hazard ratios at 1 year were 1.27 for depression and 1.83 for antidepressant initiation, with the strongest associations within the first 3 months. Causality remains uncertain. Fixed-combination CAI drops were excluded, and the database could not adjust for glaucoma severity, IOP, or visual field loss, which may independently influence depression and treatment selection.
Surgery
Three-year outcomes of phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized controlled trial
Design: Multicenter randomized controlled noninferiority trial
Journal: Asia-Pacific Journal of Ophthalmology, July 2026
Authors: Lin F et al.
In a multicenter randomized noninferiority trial, 124 eyes with advanced primary angle-closure glaucoma (PACG) and cataract were assigned to phacogoniotomy (phacoemulsification plus goniosynechialysis plus microhook trabeculotomy) or phacotrabeculectomy with mitomycin C. At 3 years, mean IOP fell from approximately 40 to 14 mmHg in both groups, and the adjusted between-group difference of -0.37 mmHg (95% CI -1.32 to 0.58) fell within the 4 mmHg noninferiority margin. Qualified success rates were comparable (90.0% vs 91.8%), though complete medication-free success numerically favored phacotrabeculectomy (78.3% vs 89.8%, P = 0.13), a difference the trial was not powered to exclude. Visual acuity, visual field stability, and endothelial cell loss were similar, with no new complications during extended follow-up. These 3-year data add randomized evidence for phacogoniotomy as a bleb-free option capable of substantial IOP lowering even in advanced patients with PACG, though the open-label design and all-Chinese cohort warrant further studies.
FDA clears the OMNI Ultra Surgical System for single-pass circumferential canaloplasty and trabeculotomy in adults with open-angle glaucoma
Dompe doses the first patient in a 272-patient phase 3 trial of intranasal nerve growth factor for nonarteritic anterior ischemic optic neuropathy, a condition with no approved treatment
FDA plans an advisory committee review of a low-dose atropine eye drop for pediatric progressive myopia, which would be the first approved pharmaceutical for the condition in the United States
Tarsus Pharmaceuticals acquires Alkeus Pharmaceuticals for $450 million upfront, plus up to $350 million in milestones, adding a phase 3 oral therapy for Stargardt disease
The first commercially produced ophthalmic viscoelastic, Healon, was manufactured from hyaluronic acid extracted from:
A. Bovine vitreous humor
B. Rooster combs
C. Human umbilical cords
D. Shark fin cartilage
See answer at bottom of newsletter.
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four articles worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
Trivia Answer: B