Topical Netarsudil May Delay Glaucoma Surgical Intervention in Children

Topical netarsudil treatment may delay glaucoma surgical intervention among the pediatric population by decreasing intraocular pressure.

Topical netarsudil 0.02% reduces intraocular pressure (IOP) in children with pediatric refractive glaucoma, potentially delaying the need for surgery, according to a study published in the Journal of the  American Association for Pediatric Ophthalmology and Strabismus.

Researchers conducted a retroscopic chart review of children (N=16; 11 boys; eyes, 21; mean age, 8.9 years) who received 0.02% topical netarsudil ophthalmic solution for pediatric glaucoma or ocular hypertension at a single center between 2019 and 2020. The primary outcome was the change in IOP, measured by palpitation, from pre-netarsudil treatment levels. Success was defined as IOP less than 21 mm Hg without the need for surgery or additional medications or the development of vision-related complications at follow-up.

A total of, 31% of patients used netarsudil in both eyes, 86% of eyes had undergone a previous glaucoma procedure, the mean number of surgeries prior to netarsudil treatment was 1.81, and the mean number of glaucoma medications used at baseline was 3.7. 

Before netarsudil treatment, mean IOP was 26.33 mmHg. After 1 month of treatment, IOP decreased to 19.60 mm Hg in 15 eyes — a 25.56% reduction from baseline (P <.01). At month 3, IOP continued to decrease from baseline by 30.61% (18.2 mm Hg) in 20 eyes (P <.01) and was maintained at a similar level until the final follow-up, during which patients experienced a 29.62% reduction from baseline (18.53 mm Hg).

Management of childhood glaucoma is challenging because of the lifelong nature of the disease and the need for multiple surgeries and medications.

Patients receiving bilateral treatment had similar outcomes in both eyes at the 1- and 12-month follow-ups.

A total of 57% of eyes (n=12) experienced successful outcomes at the final follow-up visit. The 9 eyes with inadequate treatment responses underwent glaucoma surgery. The average time from treatment to glaucoma surgery was 6.91 months.

No significant associations were observed between eye laterality, age, gender, or number of previous glaucoma surgeries and treatment success. The number of glaucoma medications was higher among patients who did not have treatment success compared with those who had treatment success (mean, 4 vs 3.5; P =.04).

The most common adverse events included conjunctival hyperemia (43%), subconjunctival hemorrhage (10%), and papillary conjunctivitis (9.5%). No patients discontinued treatment due to adverse events.

“Management of childhood glaucoma is challenging because of the lifelong nature of the disease and the need for multiple surgeries and medications,” according to the study authors. “Based on our results, we believe that topical netarsudil may be a good adjunctive IOP-lowering medication for refractory glaucoma patients on multiple medications.”

Study limitations include a retrospective nature, single center design, and small sample size.


Elhusseiny AM, Abbasain J. Topical netarsudil 0.02% as adjunctive therapy in refractory pediatric glaucoma. J AAPOS. Published online October 17, 2022. doi:10.1016/j.jaapos.2022.08.526