Preoperative Use of the Rho Kinase Inhibitor Ripasudil Protects the Corneal Endothelium from Trabeculectomy-Induced Damage

Yamato Katsura,* Hisataka Fujimoto,* Masashi Takata, Hiroshi Yokoyama, Tomohiro Sekiya, Fumi Gomi Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Hyogo, Japan*These authors contributed equally to this workCorrespondence: Hisataka Fujimoto, Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Hyogo, Japan, Tel +81-798-45-6462, Email [email protected]: Rho kinase inhibitors have emerged as treatment options for glaucoma and corneal endothelial disorders. Ripasudil, a Rho kinase inhibitor, has been approved for clinical use in glaucoma; however, further investigations are warranted for its use in the treatment of corneal endothelial disorders. We aimed to evaluate the effectiveness of preoperative ripasudil in reducing corneal endothelial damage following trabeculectomy.Patients and Methods: This retrospective observational study included a total of 139 consecutive eyes with primary open-angle glaucoma that underwent trabeculectomy; of these, 68 underwent trabeculectomy alone, whereas 71 underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation. A total of 67 eyes were treated with 0.4% ripasudil eye drops twice daily for > 3 months until the day before trabeculectomy (ripasudil group). The remainder did not receive preoperative ripasudil (without-ripasudil group). No patients received ripasudil postoperatively. The primary measures included changes in corneal endothelial cell density following surgery. The mean follow-up period was 71.6 days.Results: Among the 139 trabeculectomy eyes, the ripasudil group demonstrated a significantly lower mean endothelial cell density loss (− 0.16%) than the without-ripasudil group (6.66%) following surgery (p < 0.001). Among the 71 trabeculectomy+phacoemulsification+intraocular lens implantation eyes, the ripasudil group demonstrated a significantly lower mean endothelial cell density loss (0.97%) than the without-ripasudil group (7.70%) following surgery (p < 0.05).Conclusion: Preoperative administration of ripasudil eye drops may help maintain the functional integrity of the corneal endothelium in patients with glaucoma who underwent trabeculectomy.Keywords: rho kinase, glaucoma, trabeculectomy, ripasudil