Corneal Endothelial Cell Loss Possible Side Effect of Selective Laser Trabeculoplasty

Optometrist examing patient’s eyes
The study evaluated how the glaucoma treatment affects the corneal using data from a randomized, phase 3 study.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of The Association for Research in Vision and Ophthalmology (ARVO), held virtually from May 1 to 7, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the eye and vision experts at ARVO. Check back for more from the ARVO 2021 Meeting.


Selective laser trabeculoplasty (SLT) is increasingly being used as first-line therapy to reduce intraocular pressure (IOP) for patients with ocular hypertension or glaucoma. Prior studies have reported transient corneal changes and reductions in corneal endothelial cell density after SLT after 1 month. Investigators evaluated corneal endothelial cell loss associated with SLT treatment during 52 weeks, and presented their findings at the Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting.

During the randomized, paired-eye comparison study, researchers compared bimatoprost implants with SLT. The study recruited patients with open-angle glaucoma or ocular hypertension whose IOP wasn’t well managed with topical medication for reasons other than medication efficacy. Patients were randomized to receive treatment with an implant or SLT in the worse eye. Contralateral eyes received the alternate treatment. Treatment began on Day 1. Corneal endothelial cell density was assessed several times during the study. 

The mean (SD) corneal endothelial cell density (CECD) in SLT-treated eyes (n=141) was 2487 (311) cells/mm2 at baseline and decreased during the study. At Week 24, the mean (SD) CECD was 2422 (329) cells/mm2. Among all SLT-treated eyes, 9.9% (14/141) had 10% or greater corneal endothelial cell loss (CECL), 5.7% (8/141) had 15% or greater CECL, and 3.5% (5/141) had 20% or greater CECL during a mean (SD) follow-up of 317 (83) days.

Investigators conclude that persistent corneal endothelial cell loss may be a previously unrecognized side effect of SLT that becomes evident with longer follow-up.

Disclosure: Some of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

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Craven E, Chen M, Gu X, et al. Corneal endothelial cell loss associated with selective laser trabeculoplasty. Poster session. Presented at the Association for Research in Vision and Ophthalmology (ARVO) annual meeting; May 1-7, 2021. Abstract 3527812.