Safety And Effectivity Of Descemet Stripping Only Supplemented With Ripasudil

Fuchs endothelial corneal dystrophy (FECD) is the most common corneal endothelial dystrophy leading to corneal edema. Descemet stripping only (DSO) is gaining acceptance as a surgical option for a subset of patients with FECD. The addition of Rho-associated kinase inhibitors appears to improve results, but evidence is not yet conclusive. This study aims at reporting the efficacy and safety of DSO supplemented with ripasudil at a reference center in Spain.

Study carried-out at the Centro de Oftalmología Barraquer, a single tertiary referral hospital, between March 2019 and November 2023. Three experienced surgeons performed the same surgical procedure.

Retrospective study of DSO performed in FECD eyes with a superior midperipheral endothelial cell count (ECC) >1,000/mm2, symptomatic from the presence of central guttata and/or edema degrading vision and/or glare. A minimum follow-up of 3 months was required. DSO was carried out with a mean diameter of 4.9 ±1.7 mm, by a peeling technique alone (n=11) or combined with cataract extraction (n=3). Ripasudil 0.4% was applied topically, from day 1 postoperatively, 6 times/d until corneal clearance. Cases with relapse of edema were treated with ripasudil 0.4%, 4 times/d. Uncorrected (UCVA) and corrected visual acuity (BCVA), time of corneal clearance and treatment, ECC, and adverse events were recorded.

14 eyes of 14 patients were treated (9 female; mean age= 65.4 ±10.75 years; range: 83-45). Mean follow-up was 10.71 ±9 months (range: 3-35). 6 of 14 eyes (42.85%) achieved corneal clearance at 5.7 ± 3.54 months (range: 2-9). 83% of the successful cases were >60 years old. Mean improvement in UCVA and BCVA was, respectively, 0.42 ±0.22 and 0.59 ±0.39 LogMAR. The mean postoperative ECC was 1,275 ± 652/mm2 in the upper midperipheral area. 7 eyes failed to clear: 4 underwent DMEK and 3 DSAEK at a mean time of 12 months. One eye experienced recurrence and underwent DSAEK 4 months later. The most common side effect of ripasudil was ocular irritation. No patient experienced a serious adverse event during the study.

Our study confirms that DSO plus ripasudil can restore corneal clarity in selected FECD patients, having a good safety profile. Compared to other published series, the lesser rate of clearing (6 of 14 eyes) indicates that adding ripasudil does not guarantee success. This may be due to different patient and surgical factors, which remain poorly defined. The response to DSO may vary according to FECD subtypes, as suggested by the higher success rate in older patients. Considering our results, the usual inclusion criteria of ECC >1,000/mm2 in one or more peripheral fields may not be sufficient. Further studies are required to better define the indication criteria for DSO, and to evaluate its long-term efficacy and safety.