LoBue Stephen A, Moustafa Giannis A, Vu Anderson, Amin Mira, Nguyen Thanh, Goyal Himani
Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY.
School of Medicine, St. George's University, West Indies, Grenada; and.
Cornea. 2021 Aug 1;40(8):1048-1054. doi: 10.1097/ICO.0000000000002621.
To describe cases in which netarsudil ophthalmic solution 0.02% precipitated reversible, reticular cystic epithelial edema.
A retrospective case review at the Brooklyn Veteran's Association Hospital of patients with corneal stromal edema that were treated with netarsudil and subsequently developed cystic epithelial edema.
Four male patients with a mean age of 72 ± 8.0 years developed a reticular, honeycomb-like pattern of epithelial edema located in the interpalpebral and inferior cornea. In 3 of 4 patients, epithelial edema arose within 1 month compared with 2 months in 1 patient. New epithelial cysts did not correlate with worsening central corneal thickness and best spectacle-corrected visual acuity in every patient, which was likely due to the location of the cysts. Two of 4 patients developed increased central corneal thickness with worsening best spectacle-corrected visual acuity. In comparison, 1 patient had improvement in both parameters, whereas 1 patient had no significant change. In all cases, there was resolution of the epithelial cysts after discontinuation of netarsudil.
Although rho-kinase inhibitors have been suggested to improve endothelial function, we have documented worsening epithelial cysts in a subset of patients with pre-existing corneal edema. These effects of netarsudil were transient and resolved after discontinuing treatment within 2 weeks in most patients. We hypothesize that the incidence of this adverse finding is more common than previously believed. Nevertheless, large-scale studies are needed to accurately report on the incidence and clinical significance of this novel finding.
描述0.02%奈他地尔滴眼液引发可逆性网状囊性上皮水肿的病例。
对布鲁克林退伍军人协会医院中接受奈他地尔治疗后出现角膜基质水肿并随后发展为囊性上皮水肿的患者进行回顾性病例分析。
4名平均年龄为72±8.0岁的男性患者出现了位于睑裂区和下角膜的网状、蜂窝状上皮水肿模式。4名患者中有3名在1个月内出现上皮水肿，1名患者在2个月内出现。新的上皮囊肿与每位患者中央角膜厚度的恶化和最佳矫正视力的下降并无关联，这可能是由于囊肿的位置所致。4名患者中有2名中央角膜厚度增加，最佳矫正视力恶化。相比之下，1名患者这两个参数均有改善，而1名患者无显著变化。在所有病例中，停用奈他地尔后上皮囊肿均消退。
尽管有人提出Rho激酶抑制剂可改善内皮功能，但我们记录到一部分已有角膜水肿的患者出现上皮囊肿恶化的情况。奈他地尔的这些作用是短暂的，大多数患者在停药后2周内症状消退。我们推测这一不良发现的发生率比之前认为的更为常见。然而，需要进行大规模研究来准确报告这一新发现的发生率和临床意义。
