Reversible Corneal Endothelial Abnormalities With Netarsudil

Abstract

Purpose: To report a case of reversible corneal endothelial abnormalities after treatment with netarsudil. Observation: A 68-year-old woman presented with the complaint of blurred vision soon after starting treatment with the fixed-dose combination of netarsudil and latanoprost (FC-netarsudil-latanoprost). She had been receiving the fixed-dose combination of dorzolamide and timolol and latanoprost for primary open-angle glaucoma until her ophthalmologist switched latanoprost to FC-netarsudil-latanoprost 2 months before referral to our center. Best-corrected visual acuity was 20/20-1 in the right eye and 20/20-3 in the left eye. The slit-lamp biomicroscopic examination was remarkable for a guttata-like abnormality of the corneal endothelium of both eyes. The intraocular pressure was 10 mm Hg in both eyes. Specular microscopy revealed irregularly shaped corneal endothelial cells with indistinct borders between cells. FC-netarsudil-latanoprost was replaced with latanoprost in the left eye but continued in the right eye. Nine weeks later, best-corrected visual acuity remained 20/20-1 in the right eye but it improved to 20/20 in the left eye. Repeat specular microscopy was unchanged in the right eye and was normal in the left eye. Conclusion and Importance: Topical therapy with netarsudil can result in guttata-like changes of the corneal endothelium and corneal endothelial cell abnormalities that can be detected with specular microscopy. These abnormalities seem to be transient and resolved upon the cessation of netarsudil. Ophthalmologists should consider the possibility of a corneal endothelial abnormality in patients treated with netarsudil who develop blurred vision.

Targeted Delivery of Cell Softening Micelles to Schlemm's Canal Endothelial Cells for Treatment of Glaucoma

“…[4,5] While these drugs are effective at lowering the elevated IOP associated with glaucoma, they are hindered by prevalent, local side effects including conjunctival hyperemia, subcon junctival hemorrhages, corneal verticillata and other corneal abnormalities associated with blurry vision including irregularly shaped corneal endothelial cells and guttatalike changes. [6,7] Due to these adverse offtarget effects, we sought to develop and optimize a nanocarrier platform employing a targeting moiety for selective intracellular delivery to SC cells as a glau coma treatment strategy. Nanomaterials have been shown to be advantageous drug delivery platforms that are wellsuited for targeting specific cells and tissues.…”

“…[ 4,5 ] While these drugs are effective at lowering the elevated IOP associated with glaucoma, they are hindered by prevalent, local side effects including conjunctival hyperemia, subconjunctival hemorrhages, corneal verticillata and other corneal abnormalities associated with blurry vision including irregularly shaped corneal endothelial cells and guttata‐like changes. [ 6,7 ]…”

Netarsudil-associated reticular corneal epithelial edema

“… 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. 16 …”

A tissue-engineered human trabecular meshwork hydrogel for advanced glaucoma disease modeling

“…In the United States, only the recently approved Rhoassociated kinase (ROCK) inhibitor netarsudil 21 directly aims at the stiffened HTM to increase AH outflow via cell/tissue relaxation [22][23][24][25][26] . However, various adverse events at the ocular surface in some patients have been reported during the drug's brief window of availability [27][28][29] , raising concerns over its routine use. This highlights the clear unmet need for new/improved POAG treatment strategies.…”