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Symptomatic Netarsudil-Induced Verticillata

To identify the key insights or developments described in this article
1 Credit CME

An 80-year-old woman presented with new-onset hazy vision and glare for 5 months after starting netarsudil for severe primary open-angle glaucoma. She was noted to have corneal verticillata in both eyes (Figure) and conjunctival hyperemia but no corneal edema. Although the visual acuity remained stable at her baseline of 20/25 OD and 20/20 OS, there were no other findings to explain her symptoms, and her symptoms began to improve just 1 week after discontinuing netarsudil. Netarsudil ophthalmic solution, 0.02%, is a rho-kinase inhibitor used to lower intraocular pressure (IOP) in open-angle glaucoma, and corneal verticillata are a known adverse effect.1 In the Rho-Kinase Elevated IOP Treatment Trial 1 and 2 (ROCKET-1 and ROCKET-2) trials, vortex keratopathy occurred in up to 26% of patients and had no visual relevance.2,3 We present our case to make clinicians aware that netarsudil can be associated with corneal changes that may be symptomatic, as in this patient.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Erin A. Boese, MD, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242 (erin-boese@uiowa.edu).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Wu  JH , Chang  SN , Nishida  T , Kuo  BI , Lin  JW .  Intraocular pressure-lowering efficacy and ocular safety of rho-kinase inhibitor in glaucoma: a meta-analysis and systematic review of prospective randomized trials.   Graefes Arch Clin Exp Ophthalmol. 2022;260(3):937-948. doi:10.1007/s00417-021-05379-7PubMedGoogle ScholarCrossref
2.
Kahook  MY , Serle  JB , Mah  FS ,  et al; ROCKET-2 Study Group.  Long-term safety and ocular hypotensive efficacy evaluation of netarsudil ophthalmic solution: rho kinase elevated IOP treatment trial (ROCKET-2).   Am J Ophthalmol. 2019;200:130-137. doi:10.1016/j.ajo.2019.01.003PubMedGoogle ScholarCrossref
3.
Serle  JB , Katz  LJ , McLaurin  E ,  et al; ROCKET-1 and ROCKET-2 Study Groups.  Two phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure: rho kinase elevated IOP treatment trial 1 and 2 (ROCKET-1 and ROCKET-2).   Am J Ophthalmol. 2018;186:116-127. doi:10.1016/j.ajo.2017.11.019PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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