Comparison of Dorzolamide and Netarsudil on Intraocular Pressure and Ocular Perfusion in Early Glaucoma: A Randomized Controlled Trial.

PRECIS

Netarsudil shows promise as a second-line drug in early glaucoma patients with an increase in most OCTA parameters as compared with Dorzolamide, with comparable rates of side effects.

OBJECTIVE

To compare the effect of Netarsudil and Dorzolamide on macular and optic nerve head (ONH) perfusion changes on Optical Coherence Tomography Angiography (OCTA), and macular ganglion cell layer (mGCL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on OCT in preperimetric/early glaucoma patients.

PARTICIPANTS AND METHODS

In this prospective, randomized, parallel group, active-controlled trial 90 preperimetric/early glaucoma eyes were recruited. The primary outcome measure was change in macular and ONH perfusion, and intraocular pressure (IOP). A total of 95 patients were randomized and 45 were prescribed Netarsudil 0.02% (group 1) and 45 were prescribed Dorzolamide 2% (group 2). The IOP, ONH perfusion, ONH flux index (FI), and macular vessel density (mVD) on OCTA; pRNFL thickness and mGCL thickness on OCT of the 2 groups were recorded at baseline, 4 months, 8 months, and 12 months.

RESULTS

The mean baseline IOP in group 1 was 19.52±3.2 mm Hg and in group 2 it was 19.5±2.97 mm Hg. Group 1 showed 2.77 mm Hg (13.23%±8.27%) decrease in IOP ( P <0.001), while group 2 showed 1.85 mm Hg (8.98%±7.32%) decrease in IOP ( P <0.001) at 12 months. Group 1 showed 1.58 mm/mm 2 increase in mVD ( P <0.001), and 0.03 (7.6%) increase in ONH FI ( P <0.001) at 12 months. However, no trend in mVD or ONH FI was seen in group 2. Group 1 showed 1.03% increase in ONH perfusion ( P <0.001), while group 2 showed 1.16% increase in ONH perfusion ( P <0.001). There was no significant difference in ONH perfusion between the 2 groups. The OCT (pRNFL and mGCL) showed normal variability in both the groups. Congestion (40%) was the most common side effect observed in the Netarsudil group, while metallic taste (42.5%) was the most common side effect in the Dorzolamide group. The side effect profile of the 2 drugs was comparable ( P =0.65).

CONCLUSION

Netarsudil causes an increase in all the OCTA parameters-mVD, ONH perfusion, and ONH FI-whereas Dorzolamide causes an increase only in ONH perfusion in preperimetric/early glaucoma patients. Netarsudil monotherapy also showed a higher decrease in IOP as compared with dorzolamide therapy.