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Conjunctival histopathological changes associated with netarsudil 0.02.
Michelle T Sun1,2, Chaow Charoenkijkajorn3, Jonathan H Lin3
1Byers Eye Institute, Stanford University, Stanford, CA, USA. michelle.sun@adelaide.edu.au.
Eye (London, England)
|October 9, 2025
Summary
Topical netarsudil 0.02% use in glaucoma patients was associated with significantly thicker conjunctival epithelium and a higher likelihood of conjunctival inflammation. These changes may impact surgical outcomes, warranting further investigation.
Area of Science:
- Ophthalmology
- Histopathology
Background:
- Glaucoma management often involves multiple topical medications.
- Netarsudil is a Rho-kinase inhibitor used for lowering intraocular pressure (IOP).
Purpose of the Study:
- To investigate histopathological changes in the conjunctiva of patients using topical netarsudil 0.02%.
Main Methods:
- Observational comparative case series of conjunctival specimens from glaucoma surgery patients.
- Histopathological analysis and inflammation scoring by three independent pathologists.
Main Results:
- Patients using netarsudil showed significantly thicker conjunctival epithelium (90.1 µm vs 43.2 µm) and a trend towards higher epithelial cell thickness.
- All netarsudil-treated samples exhibited inflammation (≥0.5 score) compared to 64.7% of non-netarsudil users (p=0.03).
- No significant histopathological differences were found in patients who had ceased netarsudil prior to analysis.
Conclusions:
- Conjunctiva exposed to netarsudil may exhibit increased inflammation compared to other glaucoma medication regimens.
- These histopathological findings could have implications for glaucoma surgery outcomes.
- Further studies are needed to correlate these changes with clinical outcomes.
