03/31/2021
Glaucomatous Progression
These two images were taken 11 months apart and show clear signs of glaucomatous progression in this formerly uncontrolled POAG patient.
Rhopressa (netarsudil 0.02%) was added to the medical therapy for this patient which improved his IOP significantly and has been sustained for several months.
Rhopressa is a Rho kinase (ROCK) inhibitor dosed once daily for glaucoma or OHTN. It works by lowering resistance to outflow through the trabecular meshwork and decreases episcleral venous pressure.
How does it work? Rho kinase enzymes found in the trabecular meshwork promote contraction of actin-myosin stress fibers. This leads to increased stiffness and decreased outflow. ROCK inhibitors bind Rho kinase and prevent actin-myosin binding which in turn relaxes fibers in the trabecular meshwork. This improves aqueous outflow and lowers IOP.
Clinical Pearls
1. Dosed once daily (usually in the evening)
2. Can lower IOP an additional ~4mmHg
3. Most common adverse reaction is conjunctival hyperemia (~50% of patients)
4. Studies show an IOP reduction of 20% when added to a prostaglandin or to a combination of therapies.
@ Los Angeles, California
