Efficacy of the Rho-Kinase Inhibitor for Corneal Endothelial Protection in Fuchs Endothelial Corneal Dystrophy After Phacoemulsification.

PURPOSE: To evaluate the efficacy of Rho-kinase (ROCK) inhibitors in corneal endothelial protection in Fuchs endothelial corneal dystrophy (FECD) after phacoemulsification.

METHODS

Forty-eight eyes from 31 patients with FECD and cataracts were randomly assigned to receive either the topical ROCK inhibitor (or ripasudil) or placebo 4 times a day, in addition to the standard antibiotic and antiinflammatory eye drops, for 1 month after phacoemulsification. Endothelial cell density (ECD), central corneal thickness (CCT), and corneal densitometry were measured. The primary outcome was the central ECD (C-ECD) loss percentage 3 months after phacoemulsification. Secondary outcomes included C-ECD loss and paracentral ECD loss percentages and the CCT change ratio at different time points after phacoemulsification. Adverse events were evaluated.

RESULTS

There was significantly less cell loss among those eyes treated with ripasudil. C-ECD significantly increased from a baseline of 2361 cells/mm 2 (95% confidence interval, 2151-2571) to 2506 cells/mm 2 (95% confidence interval, 2296-2716) 3 months after phacoemulsification. The paracentral ECD loss was 0.4% in the ripasudil group versus 7.3% in the control group. Corneal densitometry remained relatively unchanged in the ripasudil group but increased significantly over time in the control group. The mean CCT increased slightly in both groups from baseline to the final follow-up at 3 months, albeit without significant differences between the groups. In the ripasudil group, transient conjunctival erythema was the most common adverse event.

CONCLUSIONS

The topical ROCK inhibitor, or ripasudil, demonstrated beneficial effects on preventing endothelial cell loss and improving endothelial function in patients with FECD undergoing phacoemulsification. Corneal densitometry showed reduced corneal light scattering in the ripasudil group after phacoemulsification, suggesting improved corneal endothelial function.