Netarsudil -Induced Corneal Edema: A Case Report

To describe a case of reversible reticular corneal epithelial edema associated with the topic use of Roclanda (netarsudil/latanoprost) for elevated intraocular pressure in a patient with chronic corneal edema and to highlight  the clinical features revealed by anterior segment optical coherence tomography (AS-OCT)

Hospital Infanta Cristina Department of Ophthalmology. Madrid, Spain.

A 80-year-old man was referred to our Hospital presenting high intraocular pressure (IOP) and corneal decompensation in his righ eye after complicated cataract surgery and the implantation of a FIL-SSF intraocular lens two years prior.
For IOP management, initial treatment with dorzolamide/timolol was established and had to be switched due to the onset of palpitations so treatment with topic netarsudil/latanoprost was initiated.
The patient showed a decrease in IOP, but after one month he developed reticular corneal epithelial edema appearing as multiple superficial bullae arranged in a reticular pattern and severe eyelid dermatitis and conjunctival hyperemia. AS-OCT imaging was performed and netarsudil was discontinued.

Anterior segment optical coherence tomography (AS-OCT)  demonstrated the presence of superficial epithelial edema after initiation of topical netarsudil.
One month after stopping the treatment, the patient showed marked improvement of the palpebral dermatitis and conjunctival hyperemia and slit-lamp examination revealed a complete resolution of the reticular corneal epithelial edema which was also confirmed by AS-OCT images.

Netarsudil is a Rho-kinase inhibitor that effectively reduces IOP and the most common side effect is conjunctival hiperemia.
Rho-kinase inhibitors have also found use in treating corneal edema, possibly by enhancing function of corneal endothelial cells or encouraging their migration. However, a reversible reticular bullous epithelial corneal edema has  been described as a rare finding associated with topical netarsudil use, more likely to occur in those who have predisposing risk factors or prior surgeries but the mechanism by which this side effect happens remains unclear.
AS-OCT is a useful adjunctive tool for the assessment of the superficial epithelial edema and for monitoring corneal surface changes after discontinuation of treatment.