Abstract
Purpose :
Ripasudil is a rho-kinase inhibitor that is approved in Japan as a twice daily treatment for glaucoma. Ripasudil has gained popularity recently, particularly when used in conjunction with Descemet stripping only (DSO) to hasten visual recovery. Ripasudil has been shown to increase corneal endothelial cell proliferation, intercellular adhesion, and decrease endothelial cell apoptosis. We present 4 cases in which persistent corneal edema following various anterior segment surgeries was successfully treated with ripasudil.
Methods :
Retrospective chart review revealed 4 patients who were started on ripasudil due to persistent corneal edema that failed to improve with conventional, non-surgical treatments.
Results :
All patients were women. The median age was 73 (mean age was 73, range 66-80. Each patient had symptomatic, persistent corneal edema following anterior segment surgery. All cases achieved improved vision and resolution of edema with the use of ripasudil after 4-6 weeks. One patient had a DSEK that required re-bubbling twice, but had persistent nasal detachment and edema involving the visual axis. Topical Ripasudil 4 times daily was initiated. After 1 month the graft was adherent to the host with resolution of edema. One patient had corneal edema involving the temporal 50% of a penetrating keratoplasty graft following routine cataract surgery which did not improve after intensive topical and oral steroids. The edema cleared after one month on ripasudil. Two patients had persistent edema after cataract surgery. Both patients failed to improve over time with topical steroids or hypertonic sodium chloride ointment. Ripasudil improved the patients' edema and vision after 4-6 weeks of use.
Conclusions :
In patients with corneal edema resulting from surgical trauma to the endothelium, who failed to clear over time despite conservative measures, ripasudil was shown to be an effective treatment option that helped prevent the need for endothelial transplantation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.