Netarsudil-induced reticular epithelial oedema: An uncommon side effect

Abstract

Netarsudil ophthalmic solution 0.02% (Netalo) is a new drug in the armamentarium for lowering intraocular pressure in open-angle glaucoma or ocular hypertension. It is a rho-associated protein kinase (ROCK) and norepinephrine transporter inhibitor with multiple mechanisms of action at various cellular levels. Apart from its effect on glaucoma, it has been reported to be beneficial in acute corneal endothelial damage. Its reported common side effects are conjunctival hyperaemia, corneal verticillata and subconjunctival haemorrhage. Corneal oedema arising from its use has been infrequently reported from abroad. We have presented two cases of such oedema acutely induced by Netarsudil, in the absence of any pre-existing corneal problems and which resolved on discontinuation. Such incidences warrant further studies to understand their clinical significance, the mechanism of corneal oedema arising from ROCK inhibitors and the use of these drugs in patients with compromised corneas.