Netarsudil on KDB-treated Eyes

ABSTRACT
Purpose: To compare the intraocular pressure (IOP) lowering effects of netarsudil on goniotomy-treated eyes versus goniotomy-naïve control eyes.
Design: Retrospective cohort study
Methods: Institutional retrospective review was conducted on 70 eyes from 49 adult glaucoma patients treated with netarsudil. 35 eyes received sectoral goniotomy using a Kahook Dual Blade (KDB) combined with cataract surgery with minimum of 3 months prior to netarsudil treatment. 35 eyes in the control cohort received only cataract surgery prior to netarsudil. Primary outcome was treatment success, defined as ≥ 20% decrease in IOP at minimum 1 month follow-up. Secondary outcome measures included percent of IOP reduction, adverse effects of medication, medication discontinuation rate, and relationship between KDB goniotomy response and netarsudil response.
Results: Eighty-three percent of KDB-treated eyes achieved netarsudil treatment success compared to 54% of control eyes (P=.012). IOP reduction was 30.3±16.2% (IQR 21-38%) in KDB-treated eyes and 19.4±12.4% (IQR 9.2-30.8) in control eyes (P=.007). History of prior KDB increased the likelihood of success to netarsudil treatment compared to eyes without prior KDB, regardless of surgical response to KDB (odds ratio 4.51, 95% CI 1.34-15.14, P=.015). The overall rate of adverse effects of netarsudil was 42%, most commonly reported as conjunctival hyperemia, allergy, and blurred vision.
Conclusions: Netarsudil had a greater IOP lowering effect in eyes treated with prior goniotomy and may serve as a promising adjunctive ocular hypotensive agent to further reduce IOP in eyes with prior goniotomy.