gms | German Medical Science

Aim: Glaucoma is a group of chronic optic neuropathies characterized by degenerative changes in the optic nerve and visual field loss. Intraocular pressure is considered the major risk factor for the progression of glaucomatous optic neuropathy involving the death of retinal ganglion cells and their axons.Netarsudil ophthalmic solution 0.02% [Rhopressa^®] is a Rhoassociated protein kinase (ROCK) inhibitor that primarily reduces intraocular pressure (IOP) by increasing the outflow of aqueous humor through the trabecular meshwork pathway.

Method: In three phases III trials of patients with elevated IOP, in patients with a baseline IOP less than 25 mmHg, the ocular hypotensive efficacy of once-daily 0.02% met the non-inferiority criteria for twice-daily timolol 0.5% over 3 months. According to a study by Kazemi A, McLaren JW, and Kopczynski which is designed to evaluate the effect of netarsudil 0.02% on aqueous humor dynamics (AHD) parameters. In this double masked study, 11 healthy volunteers received topical netarsudil ophthalmic solution 0.02% once a day for 7 days (morning dosage).

Results: The difference between netarsudil and placebo eyes in diurnal outflow change was 0.08 µL/min/mmHg (P < 0.001). Diurnal episcleral venous pressure (EVP) decreased in netarsudil-treated eyes from 7.9 ± 1.2 mmHg to 7.2 ± 1.8 (-10 percent; P= 0.01). Diurnal EVP was not significantly different between netarsudil and placebo treated eyes. Once a day, netarsudil ophthalmic solution 0.02% reduced IOP by increasing trabecular outflow and reducing EVP. This suggests a combination of mechanisms that affect both the proximal and distal outflow pathways.

Conclusion: The development of Rho kinase inhibitors for the reduction of IOP in patients with glaucoma and ocular hypertension is a triumph of medical research. Rho kinase inhibitors agents are thought to be very effective alone or in combination with other glaucoma medications. Netarsudil has neuroprotective and antifibrotic properties and enhances ocular blood flow. Therefore, it may be considered a revolutionary medication in the medical and surgical treatment of glaucoma.