Corneal endothelial wound healing after Descemet tear with a rho kinase inhibitor

Abstract

Introduction:To the authors’ knowledge, this is the first report of Descemet tear postcataract surgery that was successfully treated with ripasudil hydrochloride hydrate.Patient and Clinical Findings:An 85-year-old pseudophakic man presented with blurry vision and mild photophobia in the left eye. Slitlamp biomicroscopy showed moderate corneal edema and a central Descemet tear from cataract surgery 7 years earlier.Diagnosis, Intervention, and Outcomes:The patient was treated for 1 month with prednisolone acetate 1% and sodium chloride 5% hyperosmotic ophthalmic solution with no clinical improvement. He declined surgical intervention and opted for medical management with ripasudil 0.4% ophthalmic solution, a rho kinase inhibitor. He applied it topically 4 times daily for 3 months, with improvement of corneal edema and corrected distance visual acuity. After discontinuation of ripasudil, his edema and vision worsened and then improved again after retreatment, showing a strong clinical response. 2 years after starting ripasudil therapy, the patient had continued to use ripasudil 3 times daily and reported worsened vision at lower doses.Conclusions:The use of topical ripasudil may be a viable medical intervention for corneal edema due to Descemet tear instead of surgery, although chronic use may be required.

ROCK Inhibitors in Corneal Diseases and Glaucoma—A Comprehensive Review of These Emerging Drugs

“…Cataract or anterior segment surgeries are known to be associated with a risk of postoperative corneal oedema due to endothelial cell damage. Studies have shown that administering ripasudil in the post-operative period has a protective effect on endothelial cell density [38], and may improve visual recovery after complicated procedures [39,40]. In both Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty corneal grafts that failed to clear with conservative management, vision can be rescued with ripasudil therapy [41].…”