Reticular Bullous Epithelial Edema in Corneas Treated with Netarsudil: A Case Series

Wisely, C. Ellis; Liu, Katy C.; Gupta, Divakar; Carlson, Alan N.; Asrani, Sanjay; Kim, Terry

doi:10.1016/j.ajo.2020.04.002

Cited by 45 publications

(57 citation statements)

References 17 publications

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“…This would support the idea that inflammation increases the risk of developing reticular corneal epithelial edema, as was suggested in a previous case series describing patients with a history of anterior uveitis. 11 Curiously, case 7 immediately developed reticular corneal epithelial edema only after her second procedure at decreased laser power, and it ultimately resolved after one month despite continuation of netarsudil, which had been previous tolerated for almost 2 years. We hypothesize that her risks for developing these corneal changes were compounded by two laser procedures, as well as the added stress of Ahmed valve explantation and silicone oil granuloma excision.…”

Section: Discussionmentioning

confidence: 98%

“… 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.…”

Section: Introductionmentioning

confidence: 99%

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Netarsudil-associated reticular corneal epithelial edema

Tran

Jurkūnas

Yin

et al. 2022

American Journal of Ophthalmology Case Reports

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Purpose To describe 8 cases of reversible reticular corneal epithelial edema of the cornea that developed after use of the topical Rho-kinase inhibitor netarsudil. Methods This is a retrospective chart review case series of 8 patients treated with netarsudil at an academic medical center. Observations Patients had predisposing corneal conditions including penetrating keratoplasty, corneal decompensation after trabeculectomy-associated endophthalmitis, congenital glaucoma with Haab striae, aphakic bullous keratopathy, history of Ahmed valve and silicone oil, and Fuchs endothelial corneal dystrophy undergoing Descemet stripping only. One patient did not have clear predisposing corneal disease other than low endothelial cell density and a history of trabeculectomy. All patients developed reticular corneal epithelial edema, which appeared as collections of moderate sized superficial epithelial bullae arranged in a reticular pattern resembling a honeycomb. Most developed these changes within weeks of initiating netarsudil, but unique to this series are 2 cases in which netarsudil was tolerated by the cornea for months before developing reticular corneal epithelial edema after diode laser cyclophotocoagulation. In cases which underwent anterior segment optical coherence tomography, the imaging demonstrated that the corneal stroma was not edematous, and the reticular corneal epithelial edema involved both host and donor corneal epithelium in cases of penetrating keratoplasty. This fully resolved in all cases upon cessation of netarsudil, and this series is the first to document resolution via a pattern in which the individual bullae become smaller and more widely spaced apart. Conclusion Netarsudil can cause a reversible reticular corneal epithelial edema.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Netarsudil-associated reticular corneal epithelial edema

Tran

Jurkūnas

Yin

et al. 2022

American Journal of Ophthalmology Case Reports

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“…Treatment led to improved BVCA, and CCT, as well as eventual diminishing of corneal stromal edema, despite development of 2+ bullous, epithelial edema. 6 Similarly, LoBue et al presented a case series of 4 patients with stromal edema, treated with Netarsudil who developed reticular bullous epithelial edema. Among these four patients, one patient had improvements in both CCT and BVCA, despite reticular changes in the inferior, paracentral cornea.…”

Section: Discussionmentioning

confidence: 97%

“…Many ophthalmologists in the US are using netarsudil anecdotally to treat corneal edema; however, there are limited publications on its successful use without vision changing side effects like reticular bullous epithelial edema. 5 , 6 , 7 We provide a detailed timeline for one patient in whom it resulted in decreased corneal thickness and improved visual acuity in two very different clinical scenarios: endothelial cell loss after LPI and delayed recovery after DMEK surgery.…”

Section: Discussionmentioning

confidence: 99%

Case report: The use of netarsudil to improve corneal edema after laser peripheral iridotomy and Descemet's membrane endothelial keratoplasty

Chen

LoBue

Goyal

2021

American Journal of Ophthalmology Case Reports

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Purpose To report a case in which netarsudil ophthalmic solution 0.02% improved refractory corneal edema after laser peripheral iridotomy (LPI) and Descemet's membrane endothelial keratoplasty (DMEK). Observations A 63-year-old female presented with decreased vision due to corneal edema secondary to iatrogenic endothelial cell loss from previous YAG and argon laser peripheral iridotomy. Initial treatment with topical sodium chloride 5% solution was unsuccessful in resolving the edema. As a result, topical netarsudil was initiated off-label. Improvement in corneal thickness and visual acuity was noted, but after a few months, the left eye decompensated with worsening edema. Cataract surgery with DMEK was performed. Surgery was prolonged and intraoperative floppy iris was encountered. Post-operatively, the patient's best-corrected visual acuity (VA) fluctuated between 20/30 to 20/70 with persistent corneal edema. The central corneal thickness (CCT) ranged from 758 to 779 three months after surgery. Topical netarsudil was started again off-label for cornea edema once nightly. Over the next two months, visual acuity and CCT improved to 20/25 and 650, respectively. Stabilization of visual acuity and cornea edema has been maintained for eight months after initiation of topical netarsudil. Conclusions Netarsudil, a commercially available rho-kinase inhibitor, may be an effective, non-invasive adjunctive therapy for refractory corneal edema. Our case demonstrates improvement in BCVA and CCT using topical netarsudil, which has been maintained without any vision threatening side effects.

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“…The reviewed literature has shown positive results from the use of ROCK inhibitors on other parts of the eye, but there exist few cases of corneal edema induced by Rhopressa. A recent review reported that patients treated with Rhopressa had episodes of reticular bullous epithelial corneal edema which improved upon discontinuation of the medication [ 7 ]. These patients had a history of either corneal edema or uveitis in the affected eye.…”

Section: Introductionmentioning

confidence: 99%

Rhopressa-induced corneal edema: a case report

et al. 2021

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Background Rhopressa (netarsudil) has recently been added to the arsenal of treatment for open-angle glaucoma. It is an effective norepinephrine transporter and Rho-associated protein kinase (ROCK) inhibitor used to decrease intraocular pressure (IOP), with the most common side effect being conjunctival hyperemia. Case presentation We report a unique case of Rhopressa-induced corneal edema in a 79-year-old African-American woman, which resolved after discontinuation. She had a history of smoking one cigarette per day and did not consume alcohol. She had no history of corneal edema or uveitis. Conclusions Previous case reports have documented patients with Rhopressa-induced corneal edema; however, they have all had a preexisting history of corneal edema or uveitis. We believe that this is a unique case of Rhopressa-induced corneal edema in a relatively healthy eye. While Rhopressa is effective in managing glaucoma, there may be effects of treatment that are still unknown. We will discuss clinical findings of our case, along with a review of previous literature on Rhopressa and novel ROCK inhibitors. We hope that we can add to the existing body of literature and invite further investigation of Rhopressa and ROCK inhibitors and their effects on the cornea.

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Reticular Bullous Epithelial Edema in Corneas Treated with Netarsudil: A Case Series

Cited by 45 publications

References 17 publications

Netarsudil-associated reticular corneal epithelial edema

Netarsudil-associated reticular corneal epithelial edema

Case report: The use of netarsudil to improve corneal edema after laser peripheral iridotomy and Descemet's membrane endothelial keratoplasty

Rhopressa-induced corneal edema: a case report

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