Netarsudil-induced honeycomb keratopathy: “Bridge over troubled water”

Mamta Agarwal; Nikhil Toshniwal

doi:10.4103/IJO.IJO_3335_22

PHOTO ESSAY

Year : 2023 | Volume : 3 | Issue : 2 | Page : 543-544

Netarsudil-induced honeycomb keratopathy: “Bridge over troubled water”

Mamta Agarwal¹, Nikhil Toshniwal²
¹ Uveitis and Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
² Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India

Date of Submission	23-Dec-2022
Date of Acceptance	18-Jan-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
Mamta Agarwal
Uveitis and Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai - 600 006, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJO.IJO_3335_22

Abstract

Keywords: Honeycomb keratopathy, netarsudil, reticular pattern

How to cite this article:
Agarwal M, Toshniwal N. Netarsudil-induced honeycomb keratopathy: “Bridge over troubled water”. Indian J Ophthalmol Case Rep 2023;3:543-4

How to cite this URL:
Agarwal M, Toshniwal N. Netarsudil-induced honeycomb keratopathy: “Bridge over troubled water”. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 2];3:543-4. Available from: https://www.ijoreports.in/text.asp?2023/3/2/543/375040

A 27-year-old-Asian male with high myopia, presented with decreased vision in both eyes for the past 7 years following multiple intraocular surgeries including implantable collamer lens (ICL) implantation and removal, cataract surgery, and vitreoretinal surgery. He was referred for endothelial keratoplasty in the left eye due to corneal decompensation. His current treatment included topical antiglaucoma medications including travoprost 0.004% OD, dorzolamide-timolol 2/0.5% TID, brimonidine-timolol 0.5/0.2% BD in both eyes, and Netarsudil 0.02% TID (for 3 months) in the left eye. Slit-lamp examination in the left eye showed conjunctival congestion and diffuse corneal edema with epithelial bullae arranged in a reticular pattern resembling a honeycomb [Figure 1]a, [Figure 1]b, [Figure 1]c and [Figure 1]e. Anterior segment optical coherence tomography (ASOCT) revealed multiple hyporeflective cystic spaces separated by intervening septa suggestive of reticular epithelial edema with increased stromal thickness [Figure 1]d. Pachymetry was 744 μm, with the epithelial thickness being 110 μm. He was advised to discontinue Netarsudil eye drops following which, corneal edema was resolved in 2 weeks. Postwithdrawal pachymetry was 650 μm, with epithelial thickness of 65 μm.

Figure 1: (a-c) Slit-lamp photograph of the left eye with reticular corneal epithelial edema in diffuse illumination and cobalt blue light. (d) ASOCT showing multiple cystic spaces in the corneal epithelium. (e) Slit-lamp photograph in slit beam showing multiple epithelial bullae

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Discussion

Rho kinase inhibitors (ROCK-I) like netarsudil and ripasudil reduce intraocular pressure in open-angle glaucoma and ocular hypertension.^[1] They also enhance the corneal endothelial cell function by migration and proliferation. However, reticular corneal epithelial edema has been reported with the use of (ROCK-I) in eyes with compromised cornea and prior surgeries like keratoplasty, trabeculectomy, tube shunt, uveitis, and bullous keratopathy besides conjunctival hyperemia and cornea verticillata.^[2],[3],[4] In our patient, multiple intraocular surgeries and secondary glaucoma in the left eye led to corneal decompensation followed by reticular epithelial edema, which reversed completely following the discontinuation of netarsudil. Our case highlights that one must be aware of netarsudil-induced keratopathies, especially in eyes with coexisting corneal diseases and glaucoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2.	Fernandez MM. Reticular epithelial edema in edematous corneas treated with netarsudil. Ophthalmology 2018;125:1709.
3.	Chen H, McMillin JC, Frankfort BJ, Al-Mohtaseb Z. Reticular epithelial edema: An uncommon side effect of ROCK/NET inhibitor netarsudil. J Glaucoma 2020;29:e41-3.
4.	Tran JA, Jurkunas UV, Yin J, Davies EC, Sola-Del Valle DA, Chen TC, et al. Netarsudil-associated reticular corneal epithelial edema. Am J Ophthalmol Case Rep 2022;25:101287.