September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Intraocular pressure-lowering efficacy and safety of 0.4% ripasudil
Author Affiliations & Notes
  • Hideki Mochizuki
    Private practice, Hiroshima, Japan
    Ophthalmology, Hiroshima University, Hiroshima, Japan
  • Kazunami Noma
    Private practice, Hiroshima, Japan
  • Yoshiaki Kiuchi
    Ophthalmology, Hiroshima University, Hiroshima, Japan
  • Footnotes
    Commercial Relationships   Hideki Mochizuki, None; Kazunami Noma, None; Yoshiaki Kiuchi, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3032. doi:
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      Hideki Mochizuki, Kazunami Noma, Yoshiaki Kiuchi; Intraocular pressure-lowering efficacy and safety of 0.4% ripasudil. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3032. doi:

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Ripasudil 0.4% eye drop was first approved for use in Japan, where it was approved in December 2014 as a second-line antiglaucoma drug. This drug is the first clinically available Rho-kinase inhibitor for ocular use. It acts directly on the trabecular meshwork to lower intraocular pressure (IOP). Efficacy and safety of concomitant use with latanoprost or timolol have been reported, but the effects in concomitant use with various glaucoma therapeutic agents remain unclear. Therefore, we investigated the clinical efficacy and safety of ripasudil.

Methods : We conducted a retrospective chart review of patients who received ripasudil as an addition to or substitution for one of their glaucoma treatments. Exclusion criteria were narrow angles, intraocular surgeries within 6 months, <3 baseline IOP measurements, and <1 month follow-up. Treatment effects were analyzed with a mixed model and a t-test using the least-squares means

Results : A total of 150 glaucomatous eyes from 84 patients were analyzed. Age, number of adjunctive glaucoma agents, baseline IOP, and follow-up period were 65.0±12.1 years of age, 2.2±0.9, 13.4±2.8 mmHg, and 5.2±1.8 months (mean ±standard deviation, respectively). Addition of or switching to ripasudil reduced IOP by 1.7 mmHg at month 2. This IOP reduction ranged from 1.4–2.6 mmHg during the remaining follow-up period. Concomitant use of beta blockers, carbonic anhydrase inhibitors, or alpha 2 stimulants did not affect this reduction (p=0.309, 0.449, and 0.147, respectively). Adverse reactions were observed in 23 of 89 patients involving sustained conjunctival hyperemia (9 cases), eye pruritus (4 cases), eyelid contact dermatitis (4 cases), eye irritation (2 cases), and other reactions (4 cases). The 9-month cumulative rate for sustained hyperemia was 18%.

Conclusions : The addition of or the switch to ripasudil in patients with glaucoma generally reduced IOP without apparent systemic reactions despite low baseline IOP. It required at least 2 months from the start of ripasudil treatment to determine its IOP lowering effect. Sustained conjunctival hyperemia was noted as a local adverse reaction.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


Scatter plot of IOP change from baseline. Numbers inside figure show mean IOP change at each time point.

Scatter plot of IOP change from baseline. Numbers inside figure show mean IOP change at each time point.


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