Topical Netarsudil in Childhood Glaucoma: A Systematic Review.

Purpose: To evaluate the effectiveness and safety of topical netarsudil 0.02% in managing childhood glaucoma.

Methods: A literature search in the electronic databases of PubMed CENTRAL, Google Scholar, EMBASE, the Register of Controlled Trials, and Ovid MEDLINE from January 2017 to August 2023 using one or a combination of the following terms: "netarsudil," "rhopressa," "Rho-kinase," "pediatric glaucoma," "childhood glaucoma," "intraocular pressure" was conducted.

Results: Eight publications (four retrospective studies, one prospective study, and three case reports) were identified evaluating the outcomes of topical netarsudil in childhood glaucoma. Six publications were conducted in the United States, and two publications were conducted in India. Studies included a heterogeneous cohort of primary and secondary childhood glaucoma with a variable range of follow-up (1 week-26 months). The mean IOP reduction after the initiation of topical netarsudil 0.02% in childhood glaucoma patients varies from 0.8 ± 13.2 to 12.0 ± 0.0 mmHg. The most common ocular adverse event was conjunctival hyperemia, seen in 27 out of 82 eyes (32.9%), followed by corneal honeycombing/reticular epithelial edema, seen in 13 out of 82 eyes (15.9%).

Conclusion: Limited literature is currently available on using topical netarsudil in childhood glaucoma. However, in children with refractory glaucoma on maximum topical medications, netarsudil may serve as an adjunctive treatment option, potentially delaying the need for further surgical interventions in some patients. Careful corneal examination is needed before and after initiation of netarsudil treatment for early detection of corneal adverse events that may compromise the vision.