Topical Rho-Kinase Inhibitor For Persistent Corneal Edema After Cataract Surgery

To evaluate the early effect of topical netarsudil, a Rho-kinase (ROCK) inhibitor, on corneal edema after phacoemulsification cataract surgery using anterior segment optical coherence tomography (AS-OCT), including eyes with Fuchs endothelial dystrophy (FED).

Department of Ophthalmology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Türkiye.

This retrospective case series included four eyes of four patients who developed persistent corneal edema after phacoemulsification cataract surgery, including both early and late postoperative presentations. Two eyes had coexisting Fuchs endothelial dystrophy. All patients were treated with topical netarsudil ophthalmic solution four times daily. Central corneal thickness (CCT) was measured using anterior segment optical coherence tomography before treatment and at one-week follow-up. Best-corrected visual acuity (BCVA) and slit-lamp examination findings were recorded.

Anterior segment OCT demonstrated an early response to netarsudil therapy, with a reduction in central corneal thickness observed in all eyes as early as one week after treatment initiation. Central corneal thickness decreased from 596 µm to 561 µm, 903 µm to 764 µm, 737 µm to 635 µm in a patient with FED, and 657 µm to 578 µm in another patient with FED. This objective reduction in corneal thickness was accompanied by improvement in corneal clarity and BCVA in all cases. No patient required additional surgical intervention, including endothelial keratoplasty, during the follow-up period. Netarsudil was well tolerated, with no treatment-limiting adverse events. Transient conjunctival erythema was the most common adverse event.

Topical netarsudil was associated with a rapid and measurable reduction in central corneal thickness on AS-OCT and clinical improvement of  persistent corneal edema following phacoemulsification, including in eyes with Fuchs endothelial dystrophy. ROCK inhibitor therapy may represent a valuable non-surgical option for managing postoperative corneal edema. Larger prospective studies are warranted.