Department of Cornea and Ocular Surface, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal (A Unit of Medical Research Foundation, Chennai), India.
Department of Glaucoma, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal (A Unit of Medical Research Foundation, Chennai), India.
Indian J Ophthalmol. 2022 Apr;70(4):1163-1170. doi: 10.4103/ijo.IJO_2865_21.
To describe clinical course, characteristics, and outcome of reticular epithelial corneal edema (RECE) occurring as a not-so-infrequent adverse effect of a novel drug, Rho-kinase inhibitors (ROCK-I)- netarsudil (0.02%) and ripasudil (0.4%).
This was a retrospective observational non-randomized study. In this study, 12 eyes of 11 patients presenting at a tertiary eye care center between April 2021 and September 2021 were included. All 12 eyes developed a distinctive honeycomb pattern of RECE after starting topical ROCK-I. All patients were subjected to detailed ophthalmic examinations.
Eight patients were started on netarsudil (0.02%) and three on ripasudil (0.4%). Five eyes had a prior history of corneal edema. The remaining seven had the presence of ocular comorbidities predisposing to corneal edema. The average time for RECE occurrence was 25 days for netarsudil and 82 days for ripasudil. Visual acuity decreased in two eyes, remained unaffected in four eyes, and could not be quantified in four eyes due to preexisting profound visual impairment. Five eyes had symptoms of ocular surface discomfort associated with bullae. Symptoms and bullae resolved in all eyes in whom ROCK-I was stopped. The average time to resolution of RECE was 10 days for netarsudil and 25 days for ripasudil.
RECE after ROCK-I occurs with the use of both netarsudil and ripasudil, although the characteristics differ. The presence of corneal edema and endothelial decompensation seem to be a risk factor, and cautious use is warranted in these patients. Four clinical stages of RECE are described. ROCK-I act as a double-edged sword in patients with endothelial decompensation. Large-scale studies are required to know the exact incidence, pathophysiology, and long-term consequences of the aforementioned side-effect.
描述新型药物 Rho 激酶抑制剂（ROCK-I）-奈立定（0.02%）和利帕舒地尔（0.4%）引起的网状上皮角膜水肿（RECE）作为一种并不罕见的不良反应的临床过程、特征和结局。
这是一项回顾性观察性非随机研究。本研究纳入了 2021 年 4 月至 2021 年 9 月期间在一家三级眼科中心就诊的 11 例 12 只眼。所有 12 只眼在开始局部应用 ROCK-I 后均出现独特的蜂巢样 RECE 模式。所有患者均接受了详细的眼科检查。
8 只眼开始使用奈立定（0.02%），3 只眼开始使用利帕舒地尔（0.4%）。5 只眼有角膜水肿的既往病史。其余 7 只眼存在易引起角膜水肿的眼部合并症。RECE 发生的平均时间为奈立定 25 天，利帕舒地尔 82 天。2 只眼视力下降，4 只眼视力未受影响，4 只眼因存在严重视力损害而无法定量评估。5 只眼出现与大疱相关的眼表不适症状。停止使用 ROCK-I 后，所有眼的症状和大疱均消退。奈立定组 RECE 消退的平均时间为 10 天，利帕舒地尔组为 25 天。
使用奈立定和利帕舒地尔均可引起 ROCK-I 后 RECE，但特征不同。存在角膜水肿和内皮失代偿似乎是一个危险因素，在这些患者中应谨慎使用。描述了 RECE 的 4 个临床阶段。ROCK-I 在内皮失代偿患者中是一把双刃剑。需要进行大规模研究以了解上述副作用的确切发生率、病理生理学和长期后果。
