Background: Patients undergoing corneal transplantation are at a higher risk of graft failure with concurrent glaucoma. Despite advances in corneal transplant techniques requiring less steroid use, the risk of vision loss from glaucoma persists. Rho Kinase Inhibitors (RKIs) are a newer class of glaucoma drops that reduce intraocular pressure (IOP); however, their corneal effects are lesser known. Some reports suggest a role in corneal endothelial cell survival, while others report a reversible, reticular edema in cornea transplant patients started on RKIs. These contradictory effects make it difficult to assess the exact scenario in which RKIs help or harm the cornea. Specialists must balance the risk of vision loss from glaucoma with the potential toxicity of glaucoma therapies. The literature mostly consists of case series. This retrospective analysis aims to understand how this recently emerged glaucoma medication impacts corneal grafts. Methods: A retrospective chart review was conducted on adult patients with corneal transplants treated with topical RKIs (netarsudil 0.02%) between 2018 and 2022 at a tertiary care center. Inclusion criteria consisted of glaucoma diagnosis, any type of corneal transplant, and at least one follow-up visit post-RKI initiation. Data collected included patient demographics, ocular history, RKI use, and outcomes related to graft clarity and glaucoma management. Results: Thirty patients (mean age 64.2 years) were included. The mean number of previous ocular surgeries was 3.6, and the mean logMAR vision was 0.51. The average number of grafts prior to RKI was 1.83. At baseline, 86.67% of patients were on topical carbonic anhydrase inhibitors, and the mean IOP was 26.6 mmHg. Post-RKI, 66.66% of grafts remained clear, while 33.33% developed corneal edema. Univariate analysis identified the number of previous grafts as a significant predictor of graft failure (p=0.05). Other variables, including RKI duration, glaucoma tube shunts, and CAI use, were not significantly associated with graft failure. Furthermore, 46.7% of patients required additional glaucoma surgeries, and 20% required repeat transplants. Conclusions: Duration of RKI use did not significantly affect graft survival, though a correlation with the number of prior grafts was noted. The confounding variables and absence of a control group limit the ability to draw isolated conclusions. RKI's elusive effects on the cornea warrant further study as specialists balance mitigating glaucoma and preserving graft clarity. Further studies with larger sample sizes and control groups are necessary to better understand the role of RKIs in patients with corneal transplants and glaucoma.