The most common adverse event associated with the use of Rho kinase inhibitors is conjunctival hyperemia, which occurs in more than 50%–60% of patients and is thought to be a result of conjunctival vascular smooth muscle cell relaxation. With netarsudil, subconjunctival hemorrhages occur in approximately 15%–20% of patients; eye pruritis, punctate keratitis, increased lacrimation, blepharitis, and decreased visual acuity were each reported in about 5%–10% of patients. Cornea verticillata was observed in approximately 15%–25% of patients after 1 year of use; it is similar in appearance to that observed after long-term use of amiodarone (Fig 4-12). Cornea verticillata does not seem to adversely affect visual function and resolves after a mean of about 1 year after discontinuation of the drug. It is thought to occur as a result of lysosomal accumulation of phospholipids within corneal epithelial cells.
Figure 12-4 Cornea verticillata after use of netarsudil for 3 months.
(Courtesy of Angelo P. Tanna, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.