Netarsudil Induced Corneal Honeycombing In Childhood Glaucomas.

To study the risk factors and compare the clinical characteristics of eyes that developed corneal epithelial honeycombing with netarsudil in primary congenital glaucoma

Prospective study in a tertiary care hospital. This study was undertaken among pediatric glaucoma patients (<18 years of age) after obtaining Institute’s Ethical Committee clearance. The tenets of the declaration of Helsinki were followed and informed written consent was obtained from the guardians of the participants. Children diagnosed with glaucoma in whom target IOP was not achieved despite maximum tolerable glaucoma medications were included in the study.

 One eye of each patient (eye with higher IOP) was included in the study. The patients received a trial of netarsudil 0.02% once a day during night time (along with the previously used glaucoma medications) for at least 14 days.

 Best-corrected visual acuity (BCVA), IOP (Goldmann Applanation Tonometry), anterior segment photography was taken at baseline, and following 2 weeks of netasurdil therapy. Spectral Domain anterior segment optical coherence tomography (ASOCT) (Spectralis, Version 6.5, Heidelberg Inc.in older children and FLEX Spectralis, Heidelberg Inc.in younger children) was performed to look at corneal changes.

The mean age of the patients was 6.1 ± 4.8 years (Median: 4 years, Range: 6 months -14 years). Clinical characteristics of the patients are given in Table 1. There was a significant reduction (p<0.001) in mean IOP from 31.9  ±  8.1 mmHg to 27.6 ±  6.2 mmHg (13.8% reduction) after netasurdil therapy with a mean overall reduction in IOP being 4.2 mm Hg (range 3.5 to 6).

Eight (50%) children developed conjunctival hyperemia. Nine children (56.25%) developed corneal honeycombing (Figure 1a), seen on ASOCT as well (Figure 1b) resulting in decrease in visual acuity in all. The corneal epithelial honeycombing was transient and resolved within 1 to 3 weeks after stopping the drug.

To conclude, there is a high incidence of epithelial honeycombing in eyes of children with glaucoma after topical netasurdil therapy. This adverse effect needs to be kept in mind along with the risk factors in its causation, before prescribing netasurdil in children.