Roclanda As A Graft-Sparing Therapy: Short-Term Once-Daily Use Resolving Post-Traumatic Corneal Oedema With Ocular Hypertension

To report the use of once-daily Roclanda (netarsudil 0.02% + latanoprost 0.005%) as a graft-sparing therapy for visually significant corneal oedema secondary to presumed endothelial dysfunction with coexisting ocular hypertension. This case highlights how a short pre-operative therapeutic trial resulted in resolution of symptoms, displacement of oedema outside the visual axis, and avoidance of endothelial keratoplasty despite the development of ROCK-inhibitor–associated epithelial toxicity (“rocopathy”).

Corneal service, James Paget University Hospital NHS Foundation Trust, United Kingdom.

A 74-year-old man developed unilateral corneal oedema in the right eye following a twig injury while gardening in October 2024. After initial recovery, recurrent inferior oedema developed in 2025, causing blurred vision worse on waking and improving during the day. Examination demonstrated localised stromal oedema without keratic precipitates, anterior chamber activity, or corneal hypoesthesia; repeated viral investigations were negative. Symptoms persisted despite topical steroids, antibiotics, and antiviral therapy.

Visually significant oedema had been present for approximately 9 months at the time of intervention (≈21 months after the original trauma), and endothelial keratoplasty was being considered. The patient also developed ocular hypertension up to 26 mmHg, likely steroid-induced.

Once-daily Roclanda was initiated to address both intraocular pressure and endothelial dysfunction. Within weeks, visual acuity improved and corneal oedema regressed, becoming confined inferiorly and no longer involving the visual axis. Treatment was discontinued after a short course due to epithelial microcystic changes consistent with ROCK-inhibitor–associated reticular epithelial oedema (“rocopathy”). Despite cessation, central corneal clarity and functional vision were maintained, and keratoplasty was no longer required.

Short-term once-daily Roclanda can provide meaningful visual improvement in selected cases of endothelial-related corneal oedema, particularly when ocular hypertension coexists. By lowering intraocular pressure and enhancing endothelial pump function, treatment may redistribute oedema away from the visual axis and obviate the need for endothelial keratoplasty. Although ROCK-inhibitor–associated epithelial toxicity may limit duration of therapy, even brief use can yield durable functional benefit. A pre-operative trial should be considered before proceeding to transplantation in cases of localised or partially compensated endothelial dysfunction.