First In Vivo Confocal Microscopy Characterization Of Corneal Epithelial Alterations In Patients Treated With Netarsudil/Latanoprost Fixed-Dose Combination.
Published 2026 - 44th Congress of the ESCRS
Reference: FP08.11 | Type: Free paper | DOI: 10.82333/em1t-z060
Authors: Dr Simone Bruzio* 1 , Dr Romina Fasciani 2 , Dr Luigi Mosca 2 , Dr Andrea Giudiceandrea 2 , Dr Tommaso Salgarello 2 , A/Prof. Stanislao Rizzo 2
1Ophtalmology Unit,“A. Gemelli” Polyclinic Foundation – IRCCS,Rome,Italy, 2Ophtalmology Unit,“A. Gemelli” Polyclinic Foundation – IRCCS,Rome,Italy;Ophtalmology Unit,Catholic University of the Sacred Heart,Rome,Italy
Purpose
To provide the first in vivo confocal microscopy (IVCCM) characterization of corneal epithelial alterations in real-world clinical practice in patients treated with netarsudil/latanoprost fixed-dose combination.
Setting
Glaucoma and Cornea Service of a tertiary academic ophthalmology center (A. Gemelli Polyclinic Foundation – IRCCS, Rome, Italy).
Methods
This retrospective, observational, descriptive case series included patients treated with topical netarsudil 0.02%/latanoprost 0.005% who developed corneal epithelial abnormalities on slit-lamp examination. Twenty-five eyes of 15 patients underwent IVCCM to assess the epithelial, stromal, and endothelial microstructures. Confocal findings were correlated with slit-lamp appearance.
Results
Despite the clinical appearance of epithelial haze or opacification, IVCCM showed no inflammatory cells or stromal involvement. Two reproducible patterns of intraepithelial hyperreflective deposits were identified: (1) larger linear or curvilinear deposits in the mid-epithelium resembling verticillata-like tracks; and (2) diffuse punctate microdots across the entire epithelial thickness producing a “starry-sky” pattern. These patterns often coexisted and were associated with loss of epithelial cell-border definition without cell loss. Stromal and endothelial layers were preserved. Mild blurred vision was reported mainly in eyes with diffuse epithelial involvement without significant visual acuity reduction.
Conclusions
IVCCM revealed that corneal epithelial opacities associated with netarsudil/latanoprost therapy represent a non-inflammatory epithelium-confined phenomenon distinct from classical cornea verticillata. These findings support a pharmacologically driven epithelial remodeling effect related to ROCK inhibition and underscore the role of confocal microscopy in identifying previously unrecognized corneal drug effects in real-world settings.