Rock-Inhibitors eyedrops preventing cataract surgery induced corneal failure in Fuchs corneal dystrophy

PurposeTo evaluate the safety and efficacy of prophylactic Ripasudil in maintaining corneal endothelial function and preventing corneal failure in patients with late-stage Fuchs corneal dystrophy (FCD) undergoing femtolaser-assisted cataract surgery.Major findingsThis prospective, randomized, open-label, controlled interventional study included 41 eyes from 27 patients, 27 eyes treated with Ripasudil and 14 with hyaluronic acid as a control. Treatment was administered from 1 month before cataract surgery through 2 months postoperatively. Primary outcomes included best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density and morphology, assessed at baseline, 3 months, and 9 months after surgery. Statistical analysis was performed using the unpaired t-test with Welch's correction and the Wilcoxon matched-pairs test, with a significance threshold of <i>p</i> < 0.05. The Ripasudil group showed a significant improvement in BCVA, from0.3 ± 0.3 to 0.2 ± 0.2 LogMAR (<i>p</i> = 0.01), along with stable CCT (556.3 ± 76.4 μm at baseline vs. 563.3 ± 72.2 μm at post-operative month 3, <i>p</i> = 0.39). In contrast, the control group demonstrated no significant improvement in BCVA (<i>p</i> = 0.13) and a significant increase in CCT (from 591.9 ± 59.3 μm to 658.4 ± 74.6 μm, <i>p</i> < 0.01). Endothelial cell density, polymegathism, and pleomorphism remained stable in both groups. At 9 months, Ripasudil-treated eyes continued to show stability in both BCVA and CCT, with no adverse events reported.ConclusionRipasudil demonstrated a protective effect on the corneal endothelium during cataract surgery in late-stage FCD patients, with better visual outcomes and reduced postoperative corneal edema.