Department of Ophthalmology, Johns Hopkins Medicine/Wilmer Eye Institute, Odenton, Maryland.
Optom Vis Sci. 2022 Apr 1;99(4):400-404. doi: 10.1097/OPX.0000000000001860.
Intracorneal hemorrhages are a rare finding generally associated with surgery or trauma. There is no consensus on preferred management except eliminating or addressing the causative mechanism in hopes of reducing the risk of corneal haze or scarring.
This case highlights a rare adverse outcome of intracorneal hemorrhages occurring after recent initiation of netarsudil, possibly exacerbated by scleral contact lens wear in a patient with open-angle glaucoma and limbal stem cell deficiency.
A 77-year-old man using scleral contact lenses for therapeutic management of limbal stem cell deficiency started netarsudil for open-angle glaucoma. During an annual follow-up to adjust his scleral contact lenses, the patient developed peripheral intracorneal hemorrhages bilaterally. The intracorneal hemorrhages resolved over the course of 10 weeks after minor adjustments were made to the scleral contact lens fit and netasurdil was discontinued. Visual acuity and intraocular pressure remained stable throughout.
There are few reports of intracorneal hemorrhages associated with scleral contact lens use and even fewer associated with the use of netarsudil. This case proposes several possible causes of the intracorneal hemorrhages, including topical rho-associated kinase inhibitors, contact lens wear, and trauma. Further studies are needed to determine if netarsudil is associated with intracorneal hemorrhages, to understand the sequelae of intracorneal hemorrhages in netarsudil therapy, and to recommend management when intracorneal hemorrhages manifest with netarsudil use.
角膜内出血是一种罕见的发现，通常与手术或外伤有关。除了消除或解决致病机制外，目前尚无关于首选治疗方法的共识，希望能降低角膜混浊或瘢痕形成的风险。
本病例报告强调了一种罕见的不良反应结果，即角巩膜接触镜佩戴的开角型青光眼和边缘干细胞缺陷患者在开始使用曲伏前列素后发生角膜内出血，可能与巩膜接触镜佩戴有关。
一名 77 岁男性，因边缘干细胞缺陷而使用巩膜接触镜进行治疗，开始使用曲伏前列素治疗开角型青光眼。在年度随访以调整其巩膜接触镜时，患者双侧出现周边角膜内出血。在对巩膜接触镜的适配进行轻微调整并停用曲伏前列素后，角膜内出血在 10 周内逐渐吸收。整个过程中视力和眼压保持稳定。
与巩膜接触镜使用相关的角膜内出血报道较少，与曲伏前列素使用相关的报道更少。该病例提出了几种可能导致角膜内出血的原因，包括局部 rho 相关激酶抑制剂、接触镜佩戴和外伤。需要进一步研究以确定曲伏前列素是否与角膜内出血有关，了解曲伏前列素治疗中角膜内出血的后果，并在曲伏前列素使用时推荐治疗方法。
