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    Can You Guess February's Mystery Condition?

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    Make your diagnosis in the comments, and look for the answer in next month’s Blink.

    Mystery image Fig. 1: Fundus photo; Mystery image Fig. 2: OCT image

     

    Last Month’s Blink

    Netarsudil-Associated Bullous Keratopathy

    Written by Rebecca McGee, MD, Himani Goyal, MD, and Christina Prescott, MD, PhD, New York University Langone Medical Center. Photos by Dr. Goyal.

    Fig. 1: central corneal epithelial bullae. Fig. 2: slit-lamp photograph with fluorescein staining. Fig. 3: slit-lamp photograph with fluorescein staining. Fig. 4: anterior segment OCT.

    A 59-year-old man with a history of amblyopia, pathologic myopia, and bilateral retinal detachment repair presented with a hypermature cataract and hand-motion vision in the left eye. Cataract extraction was complicated by zonular instability, and the patient was left aphakic. Postoperative corneal edema did not improve with topical steroids and sodium chloride eye drops, so netarsudil was initiated off-label at postoperative week (POW) 3. At POW 4, the patient developed central corneal epithelial bullae in a reticular pattern (Fig. 1). Slit-lamp photographs with fluorescein staining (Figs. 2 and 3) and anterior segment OCT (Fig. 4) from POW 6 are shown. After cessation of netarsudil, the bullae resolved, but the corneal edema persisted. The patient’s vision improved to counting fingers, and he has deferred further surgery.

    Netarsudil, a rho-kinase inhibitor approved by the FDA for the management of elevated IOP, is used off-label for corneal edema. Several case reports note improvement in corneal stromal edema, but others note the development of reticular bullous epitheliopathy.1 Clin­ical trials are underway to further define the effects of netarsudil on the cornea.

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    1 LoBue SA et al. Cornea. 2021; 40(8):1048-1054.

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