Effect of Rho Kinase Inhibitors on Corneal Transplant Survival in Patients Treated for Glaucoma

Purpose: To evaluate the association between ROCK inhibitors, specifically netarsudil 0.02%, and graft survival in patients with corneal transplantation and underlying glaucoma. Methods: Retrospective chart review of adult corneal transplant recipients with glaucoma treated with topical netarsudil 0.02% for intraocular pressure (IOP) control between 2018 and 2022 at a tertiary care center. Patients were eligible if they had a documented baseline examination before ROCK inhibitor initiation and at least 1 follow-up while still using ROCK inhibitor. The primary outcome was new graft dysfunction, assessed as any newly documented corneal edema or decrease in graft clarity during the study period. Secondary outcome was to evaluate improvement in corneal edema in those with preexisting graft dysfunction. Results: Thirty patients met inclusion criteria. Graft dysfunction was present in 5 patients at baseline; among the remaining 25, 7 (28%) developed new dysfunction during follow-up. Although no variable reached statistical significance, the number of prior surgeries (hazard ratio [HR] 2.38, 95% CI, 0.95–5.96; P = 0.06) and duration of netarsudil use (hazard ratio [HR] 0.99, 95% CI, 0.99–1.0; P = 0.07) were marginally related to new graft dysfunction. No patients with graft dysfunction at baseline had improvement in corneal edema. Conclusions: In this cohort, netarsudil did not demonstrate a statistically significant effect on corneal graft survival. The number of prior ocular surgeries correlated with a higher risk of dysfunction. Further research is needed to clarify the role of ROCK inhibitors in high-risk corneal transplant populations.