Intraocular Pressure-Lowering Effect of Netarsudil Across Glaucoma Severity.

PRECIS: Netarsudil lowered IOP across all glaucoma severity stages; however, its durability appeared reduced in patients with systemic hypertension, suggesting the need for closer follow-up. PURPOSE: To evaluate the intraocular pressure (IOP)-lowering effect of netarsudil 0.02% across different stages of glaucoma severity and to investigate the influence of systemic hypertension on treatment response over time. METHODS: This retrospective study included 113 eyes of 113 patients with glaucoma who initiated netarsudil 0.02% between December 2024 and December 2025. Patients were classified into early (mean deviation [MD] >-6 dB), moderate (-6 to -12 dB), and advanced (<-12 dB) glaucoma groups based on pretreatment visual field MD. IOP was recorded at baseline, 1, 3, and 6 months. A linear mixed-effect model was used to assess the effects of glaucoma severity, time, hypertension, and their interactions on IOP. RESULTS: Baseline IOP was comparable across severity groups. Netarsudil produced a significant reduction in IOP over time (P<0.001), with no significant effect of glaucoma severity (P=0.620) or stage × time interaction (P=0.276), indicating that the IOP-lowering effect did not differ significantly according to disease stage. However, a significant interaction between time and hypertension was observed (P=0.040). Although both hypertensive and non-hypertensive patients demonstrated similar IOP reduction at 1 month, the effect was sustained in non-hypertensive patients but attenuated in hypertensive patients, who showed IOP rebound at 3 and 6 months. CONCLUSIONS: Netarsudil was associated with a significant IOP-lowering effect across all stages of glaucoma, without significant differences according to disease severity. However, the durability of its effect may be influenced by systemic hypertension, suggesting the need for closer monitoring in hypertensive patients.