Open-Angle Glaucoma (OAG) is a progressive optic neuropathy and a major cause of irreversible blindness worldwide. Lowering Intraocular Pressure (IOP) remains the most effective approach for slowing disease progression. Latanoprostene bunod (LBN) ophthalmic solution 0.024% (Vyzulta®) is a nitric oxide (NO)-donating prostaglandin analogue developed to enhance aqueous humor drainage through two complementary pathways. Following topical administration, LBN is converted into latanoprost acid and a nitric oxide-releasing metabolite. Latanoprost acid increases uveoscleral outflow, whereas nitric oxide improves conventional outflow by relaxing the trabecular meshwork and Schlemm's canal. Clinical studies have shown that LBN provides significant reductions in IOP in patients with OAG and ocular hypertension. In the phase III APOLLO and LUNAR trials, LBN demonstrated efficacy comparable to, and in some analyses greater than, timolol 0.5%. Long-term data from the JUPITER study further confirmed sustained IOP reduction during 12 months of treatment. LBN is generally well tolerated, with conjunctival hyperemia, mild ocular irritation, and instillation-site discomfort being the most frequently reported adverse events. Beyond its clinical utility, several synthetic approaches have been reported for the preparation of LBN. These include esterification and alkylation strategies involving nitrooxyalkyl derivatives, as well as routes based on bromobutyl intermediates followed by nitrate substitution. Patent literature has further described process improvements aimed at enhancing purity, scalability, and manufacturing efficiency. Overall, current evidence supports LBN as an effective and well-tolerated therapeutic option for patients with OAG or ocular hypertension. Continued improvements in synthetic methodologies may facilitate cost-effective production and broader clinical accessibility.

We present two cases with glaucoma who presented with blurred vision or metamorphopsia; the common feature was the ongoing medication with prostaglandin analogue latanoprost and neither patient received systemic corticosteroids or reported stress. Fundus image, optical coherence tomography and angiography confirmed presence of subretinal fluid and diagnosis of central serous chorioretinopathy (CSCR). These cases resolved on withdrawing the offending drug latanoprost, and when the drug was reintroduced for better intraocular pressure management, the serous detachment recurred. We analyse these cases for the role of proinflammatory and haemodynamic effects of prostaglandin analogues (PGA) on initiating CSCR. A review of other similar cases reported earlier is included. The key learning point is to consider potential association of this group of drugs with CSCR, when other risk factors have been excluded.

Pigment dispersion syndrome/pigment dispersion glaucoma (PDG) has no definitive cure and can cause vision loss in young myopes. Backward bowing of the iris can lead to rubbing of the pigmented epithelium against lens zonules and accumulation of pigment, obstructing aqueous humor outflow. We describe a case of a 37-year-old myopic man with PDG who presented to our clinic for a refractive surgery evaluation. The manifest refraction was -6.50 -0.50 x 107 in the right eye (oculus dexter (OD)) and -6.00 in the left eye (oculus sinister (OS)), which was correctable to 20/20 in both eyes (oculus uterque (OU)). Intraocular pressure (IOP) was 18 and 19 on latanoprost. Slit lamp examination revealed radial transillumination defects OU with superior and inferior thinning on nerve optical coherence tomography. Corneal topography and tomography were normal with a minimum pachymetry of 529 OD and 534 OS. Phakic intraocular lenses (IOLs; e.g., EVO implantable collamer lens (ICL)) were selected as a treatment option as they would fully correct the refractive error while providing a physical barrier between the zonules and posterior iris. On post-op day 1, the patient's uncorrected distance vision was 20/20+2 OD and 20/15 OS, with IOPs of 11 and 9 by Goldmann applanation tonometry, respectively. The ICL vault had an OD of 744 µm and an OS of 766 µm. At post-op month 1, reconfiguration of the iris contour from concave to parallel was observed. A six-month follow-up of latanoprost demonstrated stable IOP of 11 OD and 12 OS with no signs of worsening PDG in slit lamp examination or glaucoma imaging. Although larger and longer studies are needed, the newer generation of phakic IOLs, such as the EVO ICL, may have a therapeutic role in pigment dispersion by changing the iris configuration and creating a mechanical barrier between the zonules and the posterior iris.

Objective: Rho-associated protein kinase (ROCK) inhibitors have recently emerged as promising agents for the treatment of corneal endothelial dysfunction. Because corneal transparency critically depends on endothelial cell function, endothelial failure can lead to persistent visual impairment. However, clinical evidence regarding the use of topical ROCK inhibition in various etiologies of endothelial decompensation remains limited. The aim of this study was to evaluate changes in central corneal thickness (CCT), best-corrected visual acuity (BCVA), and treatment-related adverse events in eyes with corneal edema of different etiologies treated with fixed-combination drops of netarsudil 0.02%/latanoprost 0.005%, Roclanda®. Methods: In this prospective, uncontrolled, exploratory case series, we investigated the effects of topical ROCK inhibition on corneal endothelial cell function in 13 eyes of 11 patients with persistent, nonhealing corneal edema following intraocular procedures. Patients were treated with topical Roclanda® once daily for three months. Clinical evaluation included BCVA, CCT, and safety assessment. Changes in CCT and BCVA were assessed before therapy, and after 1 and 3 months of treatment. Results: Mean baseline CCT was 782.8 µm and decreased significantly by 71.0 µm at 1 month and by 120.2 µm at 3 months (p = 0.0074 and 0.0012, respectively). Complete resolution of corneal edema was achieved in 38% of eyes. Mean BCVA improved from 0.744 before treatment to 0.518 logMAR at 3 months (p = 0.0026), with 46.2% of eyes gaining two or more Snellen lines. The analysis including only one eye per patient showed similar results, with statistically significant reductions in CCT at both 1 and 3 months and a significant improvement in BCVA at 3 months after the exclusion of the second eye in bilaterally included patients. Treatment was well tolerated; with mild conjunctival hyperemia as the most common adverse effect, while reticular epithelial corneal edema occurred in one eye and resolved after the completion of the treatment. Conclusions: In this prospective, exploratory case series of patients with nonhealing corneal edema, 3 months of a fixed-dose netarsudil 0.02%/latanoprost 0.005% treatment resulted in significant reduction in CCT, as well as clinically important improvement in BCVA. These exploratory findings cannot explain the mechanism of action, but suggest a potential therapeutic role for ROCK inhibitors in eyes with nonhealing corneal edema and possibly residual endothelial reserve. Larger controlled studies are needed to confirm these observations and further define indications for treatment.