Efficacy And Safety Of Ripasudil 0.4% In Managing Various Corneal Edema Conditions: A Large-Scale Retrospective Study

To evaluate the clinical efficacy and safety of Ripasudil 0.4%, a Rho-kinase (ROCK) inhibitor, in reducing corneal edema and improving visual acuity across various etiologies, including post-cataract surgery, Fuchs' Endothelial Corneal Dystrophy (FECD), and post-endothelial keratoplasty.

Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

A retrospective cohort study of 96 eyes (96 patients, mean age 72.2 ± 12.8 years) treated with topical Ripasudil 0.4% for corneal edema. Patients were categorized into four groups: post-cataract surgery (n=38), FECD (n=26), post-DMEK (n=21), and post-PKP (n=11). Treatment regimen followed a tapering protocol: TID for one week, followed by BID. Primary outcomes included changes in Central Corneal Thickness (CCT) measured by Pentacam/OCT and Best-Corrected Visual Acuity (BCVA) in logMAR over a 3-month follow-up period.

A significant reduction in CCT was observed across all groups, with the most prominent effect in the post-cataract group (mean reduction of 30.44 ± 15.2 µm, p<0.01) and FECD group (25.56 ± 12.8 µm, p<0.05). BCVA improved significantly from a baseline of 0.82 ± 0.4 logMAR to 0.55 ± 0.3 logMAR (p<0.01) at the end of the follow-up. In the post-DMEK group, Ripasudil facilitated faster clearance of graft edema. No serious adverse events were reported; mild conjunctival hyperemia was the most common side effect (12%), which did not lead to treatment discontinuation.

Topical Ripasudil 0.4% is an effective and well-tolerated non-invasive treatment for reducing corneal edema and improving visual outcomes. It serves as a valuable therapeutic option for managing post-operative edema and may delay the need for surgical intervention in patients with endothelial dysfunction.