Real-world effectiveness and safety of a fixed-dose combination of 0.4% ripasudil and 0.1% brimonidine in the management of uveitic glaucoma

PURPOSE: To evaluate the real-world use, treatment outcomes, and tolerability of the fixed-dose combination of ripasudil 0.4% and brimonidine 0.1% (RBFC) eye drops in patients with uveitic glaucoma (UG). STUDY DESIGN: Single-center retrospective case series. METHODS: Medical records of 39 eyes with open-angle UG treated with RBFC were reviewed. The outcome measures included changes in intraocular pressure (IOP) and glaucoma drug score (GDS) at 12 months, the proportion of eyes with an IOP reduction of ≥2 mmHg at 12 months, the relationship between the duration of UG and the change in IOP at 12 months, changes in IOP in eyes switched from ripasudil plus brimonidine, and adverse events. RESULTS: The median IOP significantly decreased from 19 mmHg at baseline to 14 mmHg at 12 months (p < 0.001), while the median GDS showed no significant change, from 3 at baseline to 4 at 12 months (p = 0.562). At 12 months, 64% of eyes achieved an IOP reduction of ≥2 mmHg. A positive correlation was observed between the duration of UG and the change in IOP at 12 months (rho = 0.539, p < 0.01). In the subgroup analysis restricted to eyes switched from ripasudil plus brimonidine eye drops to RBFC, IOP showed a decreasing trend (p = 0.057). No drug-related adverse events were observed, except for transient conjunctival hyperemia. CONCLUSION: This real-world study in patients with UG showed that RBFC achieves effective IOP control while reducing treatment burden, with good tolerability, supporting its continued use in UG management.