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

Abstract

Rho kinase (ROCK) inhibitors have gained significant attention as emerging novel treatment options in the field of ophthalmology in recent years. The evidence supporting their efficacy in glaucoma and corneal pathology includes both in vitro and clinical studies. Among the available options, ripasudil and netarsudil have emerged as the leading ROCK inhibitors, and some countries have approved these therapeutic options as treatments for glaucoma. Various dosing regimens have been studied, including monotherapy and combination therapy, especially for patients with secondary glaucoma who are already on multiple medications. Another rising application of ROCK inhibitors includes their use as an adjunct in surgical procedures such as Descemetorhexis Without Endothelial Keratoplasty (DWEK), Descemet Stripping Only (DSO) to accelerate visual recovery, glaucoma surgeries to reduce scarring process and allow better intraocular pressure (IOP) control, or after complicated anterior segment surgery to treat corneal oedema. This article provides a comprehensive overview of the existing literature in the field, offering recommendations for prescribing ROCK inhibitors and also discussing patient selection, drug efficacy, and possible adverse effects.

Molecular pathways in experimental glaucoma models

“…Three of them (ripasudil, netarsudil and fasudil) are commercially used in the treatment of glaucoma in some countries. Two of the ROCK inhibitors have not been approved yet (SNJ-1656—phase II clinical trial, Y-27632—pre-clinical phase; Pagano et al, 2023 ). With the rise in the use of ROCK inhibitors by ophthalmologists, it becomes important to enhance our comprehension of the potential advantages and safety profiles associated with these pharmaceuticals, whether employed in approved or off-label capacities.…”