Netarsudil-associated conjunctival fragility

Purpose: To describe six cases of intraoperative and postoperative complications in glaucoma patients with prior or current use of netarsudil. Observation: Patients in this series all had moderate to severe glaucoma and had undergone incisional glaucoma surgery while currently or recently being exposed to netarsudil. Patients had been taking netarsudil in the affected eye for durations ranging from less than one month to six years. Most were on netarsudil within one week of the observed complication. For five patients whose surgery was done at our institution, marked conjunctival fragility was noted intraoperatively. Postoperative complications observed included tube exposures and trabeculectomy bleb leaks in the immediate postoperative period, as well as months to years later. Four of the six patients required surgical revision. Conclusion: Patients with netarsudil exposure may exhibit conjunctival fragility, which can increase the risk of intraoperative and postoperative complications from incisional glaucoma surgery.