|Year : 2023 | Volume
| 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|
Uveitis and Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai - 600 006, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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
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. 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.,, 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
Conflicts of interest
There are no conflicts of interest.
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