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Latanoprost/netarsudil Guttata-like corneal endothelial abnormalities and blurred vision: case report

A 68-year-old-woman developed Guttata-like corneal endothelial abnormalities and blurred vision during treatment with latanoprost/netarsudil for primary open-angle glaucoma. The woman, who had a history of moderate stage primary open-angle glaucoma in the right eye and suspected glaucoma in the left eye, presented with blurred vision. Two months prior to the presentation, she had started receiving topical latanoprost/ netarsudil 0.005%/0.02% [netarsudil-latanoprost; Rocklatan]once a day. Two years prior to the presentation, she had also undergone cataract extraction with phacoemulsification and posterior intraocular lens implantation combined with excisional ab interno goniotomy in both eyes. Following the surgery her vision was 20/20 and intraocular pressure (IOP) were in mid-teens and she had been receiving dorzolamide/timolol and latanoprost. Three months prior to the presentation, her visual field worsened. Therefore, the latanoprost was replaced with latanoprost/netarsudil in both eyes. Soon after that, she developed blurred vision. During the presentation her best-corrected visual acuity was 20/20-3 in the left eye and 20/20-1 in the right eye with a refractive error of –1.00 + 0.75×172 in the left eye and –1.25 + 0.75×179 in the right eye, which been stable since her prior visit. Slit-lamp biomicroscopy revealed trace corneal guttata of both eyes, well-positioned posterior chamber intraocular lens, and IOP was 10 mmHg in both eyes. Ultrasonic pachymetry revealed a central corneal thickness of 487µm OD and 494µm OS. Specular microscopy showed irregularly shaped corneal endothelial cells with polymegethism and indistinct borders. Based on clinical correlation she was diagnosed with guttata-like corneal endothelial abnormalities with blurred vision secondary to netarsudil in latanoprost/netarsudil. The woman’s latanoprost/netarsudil was replaced by latanoprost in the left eye, but she continued the latanoprost/netarsudil in right eye. Nine weeks later, the best corrected visual acuity was improved to 20/20 in the left eye, whereas it remained at 20/20-1 in the right eye. Slit-lamp biomicroscopy was unchanged in the right eye and the guttata-like abnormality was absent in the left eye. Repeat specular microscopy was normal in the left eye, but unchanged in the right eye. Tanna AP, et al. Reversible Corneal Endothelial Abnormalities with Netarsudil. Journal of Glaucoma 29: E41-E43, No. 6, Jun 2020. Available from: URL: http:// doi.org/10.1097/IJG.0000000000001507

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Reactions 3 Oct 2020 No. 1824