A Patient With Glaucoma With Corneal Edema

Netarsudil-associated reticular corneal epithelial edema

“…Furthermore, it is interesting to note the varying timeframes of reticular corneal epithelial edema development and resolution; some eyes such as case 2 and case 7 in this series seem to tolerate netarsudil for 6 or more months before onset of reticular corneal epithelial edema after an inciting factor such as CPC, while the majority develop reticular corneal epithelial edema within weeks of starting netarsudil. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Improvement has been described to occur within one week to three months. 11 Cases 1 and 8 in this series suggest that reticular corneal epithelial edema resolves via all bullae becoming smaller and more widely spaced apart.…”

“… 3 , 4 Conversely, ophthalmologists have reported several cases of worsening reticular corneal epithelial edema associated with netarsudil use in eyes with predisposing risk factors or prior surgeries that include corneal endothelial keratoplasty, penetrating keratoplasty, Fuchs endothelial corneal dystrophy (FECD) undergoing Descemetorhexis without endothelial keratoplasty (DWEK)/Descemet stripping only (DSO), Descemet stripping endothelial keratoplasty, uveitis, pseudophakic bullous keratopathy, glaucoma tube shunt, and trabeculectomy. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Most of these cases were described as corneal epithelial reticular honeycomb edema changes that completely resolved with cessation of netarsudil. Guttata-like endothelial changes with polymegathism and indistinct borders on specular microscopy have also been described, 15 but other studies have not found significant changes in endothelial cell metrics.…”

Two pediatric cases of reticular corneal epithelial edema associated with netarsudil

“…In this case series, we describe two pediatric cases of reticular corneal epithelial edema likely due to netarsudil use. Although netarsudil-induced reticular corneal epithelial edema has been reported in adult patients, 5 , 6 , 7 , 8 we report netarsudil-associated reticular epithelial edema in a six-year-old and an infant, the latter with pre-existing Haab striae. In our first case, this six-year-old patient did not develop reticular epithelial edema until approximately one year after initiating treatment with netarsudil.…”

“…In contrast to stromal edema (which can be seen post-diode laser) and to microcystic epithelial edema (which occurs after acute rapid elevations of IOP), netarsudil-induced reticular epithelial edema can be more macrocystic or can have a characteristic honeycomb appearance. 5 , 6 , 7 , 8 To our knowledge, however, this side effect has yet to be reported in the pediatric population. In this case series, we report two cases of reticular corneal epithelial edema in pediatric patients who were on netarsudil.…”

“Rapid and reversible alteration in corneal contour and power associated with Netarsudil/Latanoprost”

“… 2 , 3 , 4 , 5 While large phase 3 clinical trials have proven its efficacy and well tolerated safety profile, there have been reports of cases of reversible corneal epithelial edema with associated changes in visual acuity in patients treated with netarsudil. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 We present a novel case of induction of significant, bilateral, symmetric, and reversible corneal steepening and myopic shift with netarsudil/latanoprost in a patient with prior radial keratotomy without history of refractive instability secondary to the procedure.…”