Increase in the OCT angiographic peripapillary vessel density by ROCK inhibitor ripasudil instillation: a comparison with brimonidine

Abstract

PurposeTo assess the responses of the superficial peripapillary retinal vessel density (VD) and prelaminar flow index (PLFI) to topical Rho-assisted coiled-coil forming protein kinase (ROCK) inhibitor ripasudil and alpha-2 agonist brimonidine using optical coherence tomography angiography.MethodsThis is a prospective, non-randomized, comparative cohort study. We studied the response of optical coherence tomography angiography (OCTA) parameters to drugs in 24 eyes treated with ripasudil and 23 eyes treated with brimonidine at the Sensho-kai Eye Institute. After division by the signal strength (SS), we compared the responses of peripapillary VD/SS and PLFI/unit area (UA)/SS to topical eye drops in eyes with primary open-angle glaucoma (POAG) and ocular hypertension (OH).ResultsIn the superficial peripapillary retina, VD/SS increased significantly in the ripasudil-treated eyes (12.5 ± 21.7%, P = 0.018), but not in the brimonidine-treated eyes (− 2.0 ± 13.8%, P = 0.484). In the deeper area of the optic disc, the changes in the PLFI/UA/SS in the brimonidine-treated eyes (+ 0.9 ± 8.9%, P = 1.00) and ripasudil-treated eyes (− 1.3 ± 8.5%, P = 0.241) were not significant. Multivariate discriminant analysis showed that the change in the peripapillary VD/SS was the most important parameter (P = 0.0186) for differentiating ripasudil- and brimonidine-treated eyes.ConclusionsThe topical ROCK inhibitor ripasudil enhanced the peripapillary VD in POAG and OH, whereas the alpha-2 agonist brimonidine did not. The PLFI did not respond to either drug.Electronic supplementary materialThe online version of this article (10.1007/s00417-018-3945-5) contains supplementary material, which is available to authorized users.

Optical coherence tomographic angiography study of perfusion recovery after surgical lowering of intraocular pressure

“…Some postoperative changes may be confounding. Stopping of glaucoma medications postoperatively may influence retinal perfusion, although published results so far only showed that medications have no change or improved capillary density 49 , 50 . Ocular surface changes may affect the quality of OCTA images, although our signal strength analysis showed that preoperative and postoperative images quality were comparable.…”

Claudin-5 Redistribution Induced by Inflammation Leads to Anti-VEGF–Resistant Diabetic Macular Edema

“…However, using animal models, we previously showed that ripasudil is able to reach the retina even with eye drops and that the sufficient retinal concentration of ripasudil was maintained for at least 8 h (34). In addition, Chihara et al (49) reported that ripasudil instillation twice a day enhanced the peripapillary retinal vascular density using OCT angiography. Thus, it will be worthwhile to investigate the effects of anti-VEGF therapy and ripasudil eye drops on rDME in the future.…”

Influence of new treatment modalities on adherence in glaucoma

“…Several studies considered the efficacy of ROCK. Chihara [5] and Ohta [6] showed that Ripasudil not only lowered IOP but also increased ocular blood flow and the density of peripapillary vessels. Netarsudil and another ROCK, fasudil, enabled an IOP reduction in the range of timolol (slightly less than prostaglandin analogues), which was ongoing for a longer time.…”