Punctal Stenosis Associated with Topical Netarsudil Use

Meirick, Thomas; Mudumbai, Raghu C.; Zhang, Matthew; Chen, Philip

doi:10.1016/j.ophtha.2022.02.025

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…To our knowledge, this is the first study to demonstrate punctal stenosis and complete punctal closure after the use of topical netarsudil, with reversal of these complications upon drug cessation. On literature review, there has only been 1 other report published on punctal stenosis secondary to topical netarsudil, however, the severity of punctal changes that we reported in our patient cohort is novel 10. In 4 of our patients, we described complete punctal closure and loss of landmarks with the reappearance of the punctal opening after cessation of netarsudil.…”

Section: Discussionmentioning

confidence: 58%

“…On literature review, there has only been 1 other report published on punctal stenosis secondary to topical netarsudil, however, the severity of punctal changes that we reported in our patient cohort is novel. 10 In 4 of our patients, we described complete punctal closure and loss of landmarks with the reappearance of the punctal opening after cessation of netarsudil. This unique phenomenon is a less frequent side effect of topical antiglaucoma therapies, with an unknown incidence in the current literature.…”

Section: Discussionmentioning

confidence: 80%

“…Documented adverse effects of this novel topical glaucoma medication as observed in clinical studies and reports include conjunctival hyperemia, corneal verticillata, corneal edema, conjunctival hemorrhage, instillation site pain and erythema, corneal staining, blurred vision, increased lacrimation, eyelid erythema, and reduced visual acuity 3,5,6,9. However, punctal stenosis is not a well-documented potential adverse effect, with a single case series published to date 10. We described a series of patients who developed partial or complete punctal stenosis after the use of topical netarsudil, as well as the reversal of punctal disease after drug cessation.…”

mentioning

confidence: 99%

“…3,5,6,9 However, punctal stenosis is not a well-documented potential adverse effect, with a single case series published to date. 10 We described a series of patients who developed partial or complete punctal stenosis after the use of topical netarsudil, as well as the reversal of punctal disease after drug cessation.…”

mentioning

confidence: 99%

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Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma

Rashad

Zhu

Kupcha

et al. 2022

Journal of Glaucoma

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Purpose: To describe patients who developed partial or complete punctal closure after the use of topical netarsudil in the treatment of glaucoma, with documented reversal of symptoms on drug cessation.Patients and Methods: This is a retrospective, single-center case series including patients treated with topical netarsudil who were documented to have developed punctal disease ipsilateral to the eye (s) being treated. A literature review was also performed to identify other similar reports.Results: A total of 10 patients were included in the study. Six patients developed partial punctal stenosis and 4 patients developed complete closure of the puncta in 1 or both eye(s) ipsilateral to the use of the topical medication. None of the patients developed punctal disease on the non-netarsudil side. The time from initiation of netarsudil to the documentation of punctal disease ranged from 5-32.2 months (18.41 ± 9.94). In the patients with complete punctal closure, discontinuation of the topical medication led to clinical reappearance of the punctal opening, ranging from 31-83 days after drug cessation (45.75 ± 21.57). In 8 cases, discontinuation of netarsudil resulted in improved epiphora and degree of punctal stenosis on clinical examination. Conclusions:The use of topical netarsudil for glaucoma may lead to punctal stenosis and complete punctal closure. These side effects of netarsudil are relevant to therapeutic considerations for glaucoma patients.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 80%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma

Rashad

Zhu

Kupcha

et al. 2022

Journal of Glaucoma

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“…The pooled results from phase III clinical trials suggested that conjunctival hyperemia (54.4%), corneal verticillata (20.9%), and conjunctival hemorrhage (17.2%) are the main side effects of using 0.02% netarsudil. Recent case reports have mentioned some experiences in exceptional circumstances, such as in children, patients undergoing corneal transplantation or corneal surgery, and in cases with lacrimal point stenosis [ 27 – 29 ].…”

Section: Rock Inhibitors In Clinical Use For Glaucoma Therapymentioning

confidence: 99%

Rho-Kinase Inhibitors as Emerging Targets for Glaucoma Therapy

Wang,

Dang

2023

Ophthalmol Ther

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Glaucoma, the leading cause of irreversible blindness worldwide, is a chronic and progressive optic neuropathy characterized by damage to the optic and retinal nerve fiber layers, which can lead to permanent loss of peripheral or central vision. Reduction of intraocular pressure (IOP) is the only known modifiable risk factor for preventing and treating glaucoma. Rho kinase (ROCK) inhibitors are a new class of glaucoma drugs with a novel mechanism of action and good safety profile. They exert neuroprotective effects, act on the trabecular tissue, increase the outflow of aqueous humor, and reduce intraocular pressure. However, they also cause local adverse reactions, including common conjunctival congestion and subconjunctival bleeding; however, most are self-limiting and temporary. Netarsudil (0.02%), a ROCK inhibitor, relaxes the trabecular meshwork, increases the outflow of aqueous humor, reduces scleral venous pressure, and directly decreases IOP. Conjunctival congestion can be reduced if netarsudil is administered at night. The combination of these medications is always more effective than the single drug. Ripasudil (0.4%), another ROCK inhibitor, also lowers IOP; however, conjunctival hyperemia is the most common adverse drug reaction. The purpose of this review is to summarize the effects and adverse reactions of ROCK inhibitors in the experimental trial stage and in clinical treatment in recent years, providing suggestions for future clinical drug use, and research and development to reduce the side effects of these drugs, maximize the potential for reducing IOP, and improve the therapeutic effect.

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Netarsudil

2022

Reactions Weekly

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Punctal Stenosis Associated with Topical Netarsudil Use

Cited by 4 publications

References 17 publications

Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma

Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma

Rho-Kinase Inhibitors as Emerging Targets for Glaucoma Therapy

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