Honeycomb-like corneal edema following netarsudil eye drops in a 65-year-old previously treated for retinal detachment

Abstract

A 65-year-old man presented at Guru Nanak Eye Centre with progressively diminishing vision and ocular discomfort in the right eye. He had previously undergone complex vitreoretinal surgery with silicone oil tamponade for retinal detachment at another institution. Postoperatively, emulsified silicone oil droplets were observed in the anterior chamber, and high intraocular pressures were noted. To manage persistently elevated intraocular pressure, netarsudil 0.02% ophthalmic solution had been prescribed, among other antiglaucoma eye drops. Within days of starting netarsudil, the patient developed a distinctive honeycomb-like pattern of corneal edema, most prominent in the central and inferior paracentral cornea. This edema was associated with worsening vision and photophobia. On discontinuation of netarsudil, the corneal changes gradually resolved. Netarsudil, a rho kinase inhibitor, is known to cause unique corneal changes, including reticular or honeycomb epithelial edema, especially in eyes with compromised endothelium. The presence of emulsified silicone oil in the anterior chamber may have exacerbated endothelial dysfunction in this case and induced edema. Netarsudil must be prescribed with caution to patients with preexisting endothelial compromise, particularly in the presence of intraocular silicone oil. Early identification and withdrawal of the medication can lead to resolution of the edema and prevent further decompensation.