Visual loss after initiation of netarsudil/latanoprost: have you considered RECE?

Netarsudil may disrupt epithelial barrier function and alter the epithelial basement membrane [1], potentially allowing stromal fluid to accumulate within the epithelium: a condition termed RECE (reticular epithelial corneal edema). This adverse effect appears to be more prevalent in eyes with pre-existing endothelial compromise or stromal edema [2]. Slit-lamp examination typically reveals honeycomb-like epithelial microcysts [3], leading to blurred vision and photophobia [4]. In such cases, netarsudil/latanoprost should be discontinued, after which the epithelial oedema usually resolves progressively over days to weeks [2]. This rare complication should always be considered, particularly when prescribing netarsudil to patients with compromised endothelial function.

References

1. Schlötzer-Schrehardt U, Gießl A, Zenkel M, Bartsch A, Okumura N, Koizumi N, et al. Drug- and Cell-Type-Specific Effects of ROCK Inhibitors as a Potential Cause of Reticular Corneal Epithelial Edema. Cells. 11 févr 2025;14(4):258.
2. Troup D, Chauhan M, Guo Z, Sanvicente C, Warner D, Sallam A. Netarsudil and Corneal Edema: An Update and Review of the Literature. Clin Ophthalmol. 2025 Dec;Volume 19:4709–24.
3. Wisely CE, Liu KC, Gupta D, Carlson AN, Asrani SG, Kim T. Reticular Bullous Epithelial Edema in Corneas Treated with Netarsudil: A Case Series. American Journal of Ophthalmology. 2020 Sept;217:20–6.
4. Bhargava M, Sen S, Bhambhani V, Paul RS, Dutta C. Reticular epithelial corneal edema as a novel side-effect of Rho Kinase Inhibitors: An Indian scenario. Indian Journal of Ophthalmology. 2022 Apr;70(4):1163–70.

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