A Rare Case Of Reticular Epithelial Corneal Edema Due To Ripasudil Post -Icl In A Young Patient

To study the earliest time onset of reticular epithelial corneal edema in post ICL patient started on Ripasudlil eye drop for raised iop and corneal haze  - a side effect of drug 

Hospital based setting and Anterior segment OCT of corneal to look for Reticular epithelialcorneal edmea a side effect of Ripasudil

 21-year-old young female with a high refractive error was advised bilateral refractive surgery (phakic intraocular lens). Preoperatively Intraocular pressure was OU- 20mmHg and the anterior segment was within normal limits. A fundus examination was normal. She underwent OU phakic intraocular lens surgery under topical anaesthesia. Right eye was uneventful postoperatively. In left eye post-operative rise of intraocular pressure of 60mmHg (non- contact tonometer) was recorded. She was started on tablet acetazolamide 250mg stat; brimonidine + timolol eye drops twice a day, nepafenac eye drops two times a day, topical antibiotic with steroid combination and lubricating eye drops.  

Post-operative day 1(POD-1)-left eye intraocular pressure was 40 mmHg, stromal  corneal edema as shown in figure A, for which she was continued with same treatment. Patient was kept on close follow-up. On Post-operative day 5- IOP was 30mmHg with persistence of corneal edema for which she was started on Ripasudil eye drop (0.4%) twice a day. Two days later i.e., On Post-operative day 7 - IOP was 23mmHg and had developed epithelial edema with localized honeycomb appearance suggestive of reticular epithelial corneal edema on anterior segment optical coherence tomography as shown in figure B. Ripasudil (0.4%) eye drop was discontinued. On Post-operative day 10 –IOP was 22mmHg with resolution of epithelial and stromal corneal edema as shown in figure C.

With improvement of corneal clarity and visual acuity

CONCLUSION: Many studies showed Reticular epithelial corneal edema as a well-established side effect of ripasudil and netarsudil. The potential risk factor in our case was pre-existing corneal edema though patient had no co-morbidities. Clinicians should be vigilant for corneal complications following ocular surgeries, especially in patients receiving ROCK inhibitors. Timely recognition and management are essential to prevent long-term sequelae and ensure favourable outcomes.