Response to netarsudil in goniotomy-treated eyes and goniotomy-naïve eyes: a pilot study

Purpose To compare the intraocular pressure (IOP)–lowering effects of netarsudil on goniotomy-treated eyes versus goniotomy-naïve control eyes. Methods Retrospective cohort study of 70 eyes from 49 adult glaucoma patients treated with netarsudil. Thirty-five eyes received sectoral goniotomy using Kahook Dual Blade (KDB) combined with cataract surgery with minimum of 3 months prior to netarsudil treatment. Thirty-five 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.