Exploring the potential of rho kinase inhibitors in ophthalmology: From mechanisms to clinical practice.

The therapeutic potential of rho kinase (ROCK) inhibitors in ophthalmology is gaining attention, given their multifaceted role in cellular regulation, particularly within ocular pathologies. This review synthesizes findings from clinical and preclinical studies on the efficacy and safety of ROCK inhibitors across glaucoma, corneal, and retinal diseases. We performed a systematic database search in Ovid MEDLINE and Ovid Embase on 5th April 2022 using the following keywords: 'primary open angle glaucoma', 'glaucoma surgery', 'corneal wound healing', 'corneal endothelial dysfunction', 'diabetic retinopathy', 'diabetic macular oedema', 'age-related macular degeneration', 'rho kinase inhibitor', 'rho-kinase inhibitor', rock inhibitor', 'ripasudil', 'netarsudil' and 'fasudil'. Abstracts were screened for relevant studies and results summarized in tables. The analysis of trials done for ROCK inhibitors reveals that they are safe and efficacious drugs, demonstrating noninferiority to existing medical treatments and effective when combined with existing treatments, and are approved for use in treating glaucoma, but not corneal or retinal diseases. Questions remain, however, regarding optimal dosage, patient selection, and cost-effectiveness. ROCK inhibitors demonstrate significant efficacy in reducing intraocular pressure by improving aqueous humour outflow. Additionally, ROCK inhibitors show promise in enhancing endothelial cell migration, thus providing a novel treatment avenue for corneal diseases such as Fuchs endothelial dystrophy. In retinal conditions, including diabetic retinopathy and age-related macular degeneration, ROCK inhibitors reduce vascular permeability, inflammation, and fibrosis, stabilising disease progression.