Rho Kinase Inhibitor–Induced Visually Significant Vortex Keratopathy

Purpose: The purpose of this case report is to describe a case of visually significant vortex keratopathy in a patient using a Rho kinase inhibitor. Methods: A 69-year-old male patient was found to have bilateral vortex keratopathy while taking a Rho kinase inhibitor. The case was reviewed and detailed in this report. Results: Approximately 5 months after starting netarsudil/latanoprost, the patient complained of ongoing right worse than left blurred vision and glare. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Corneal exam was significant for vortex keratopathy with iron deposition diffusely in the right eye and mildly in the left eye. The patient underwent superficial keratectomy with diamond burr debridement in his right eye. One month after procedure, the BCVA improved to 20/25. The patient subsequently underwent the same procedure in his left eye and BCVA remained stable at 1 month. At 13 months after right eye procedure, the patient returned complaining of declined vision. There was moderate recurrent pigmented vortex keratopathy in the central visual axis in the right eye. The patient underwent repeat superficial keratectomy/diamond burr debridement in the right eye and the Rho kinase inhibitor was discontinued. The patient has been followed for approximately 31 months after stopping the medication without further recurrence of the vortex keratopathy. Conclusions: We present a case of visually significant and reoccurring vortex keratopathy in a patient taking a Rho kinase inhibitor. This case is notable as Rho kinase inhibitor–associated vortex keratopathy is typically not visually significant.