Topical Ripasudil for the Treatment of Segmental Corneal Edema: A Case Series

by Selleckchem | Jul 10 2023

Purpose: Ripasudil, a rho-kinase inhibitor, has gained popularity as an adjunctive therapy after Descemet stripping only to hasten visual recovery. Ripasudil has been shown to increase corneal endothelial cell proliferation and intercellular adhesion, and decrease endothelial cell apoptosis. We present 4 cases in which persistent corneal edema after various anterior segment surgeries was successfully treated with topical ripasudil, and 1 case in which corneal edema did not improve with use of ripasudil.

Methods: Retrospective chart review revealed 5 patients treated with topical ripasudil for persistent corneal edema that failed to improve with conventional, nonsurgical treatments.

Results: In each case, the patient had symptomatic, persistent, focal corneal edema which followed a surgical procedure in the anterior segment. The various etiologies of corneal edema included graft failure after Descemet stripping endothelial keratoplasty, a failed penetrating keratoplasty, and 3 cases of pseudophakic corneal edema. These patients experienced improved vision and partial or complete resolution of corneal edema after 2 to 4 weeks of topical ripasudil administered 4 times daily. One patient with pseudophakic bullous keratopathy had edema that initially improved on topical ripasudil, but after cessation of the medication, developed progressive corneal edema and required endothelial keratoplasty.

Conclusions: In patients with focal corneal edema resulting from surgical trauma to the endothelium who failed to clear over time with conservative measures, topical ripasudil was shown to be an effective treatment option that in most cases improved vision and helped reduce the need for endothelial transplantation.

Comments:

The purpose of the presented study was to evaluate the efficacy of ripasudil, a rho-kinase inhibitor, as an adjunctive therapy for hastening visual recovery in patients with persistent corneal edema following anterior segment surgeries. The researchers conducted a retrospective chart review of five patients who were treated with topical ripasudil after conventional nonsurgical treatments failed to improve their corneal edema.

The study results showed that all five patients had symptomatic and persistent focal corneal edema following anterior segment surgeries. The underlying causes of corneal edema varied and included graft failure after Descemet stripping endothelial keratoplasty, a failed penetrating keratoplasty, and pseudophakic corneal edema. However, in all cases, the patients experienced improved vision and either partial or complete resolution of corneal edema after 2 to 4 weeks of topical ripasudil administration, four times daily.

The researchers concluded that topical ripasudil was an effective treatment option for patients with focal corneal edema resulting from surgical trauma to the endothelium, who did not show improvement over time with conservative measures. The use of ripasudil not only improved vision but also reduced the need for endothelial transplantation in most cases. However, they also noted a case where corneal edema initially improved with ripasudil but progressed after discontinuation of the medication, ultimately requiring endothelial keratoplasty.

Overall, the study suggests that topical ripasudil can be considered as a viable treatment option for patients with persistent corneal edema following anterior segment surgeries, particularly when conservative measures fail to yield satisfactory results. However, it is important to closely monitor patients for potential progression of edema after discontinuation of ripasudil.