Topical ROCK inhibition accelerates recovery after Descemetorhexis Without Endothelial Keratoplasty (DWEK) in Fuchs endothelial corneal dystrophy: a prospective comparative clinical trial.

PURPOSE: To compare the clinical efficacy and recovery kinetics of Descemetorhexis Without Endothelial Keratoplasty (DWEK) performed with and without adjunctive topical ripasudil 0.4% in eyes with Fuchs endothelial corneal dystrophy (FECD).

SETTING

Cornea and Refractive Surgery Services, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.

DESIGN

Prospective, randomized, interventional, comparative clinical study.

METHODS

Twenty-four eyes with mild-to-moderate FECD underwent phacoemulsification with a standardized 4-mm central DWEK and were randomized to DWEK-alone (Group A) or DWEK + topical ripasudil 0.4% four times daily for eight weeks (Group B). Primary outcomes were changes in best-corrected visual acuity (BCVA, logMAR), central corneal thickness (CCT), and peripheral endothelial cell density (ECD) over 6 months. Secondary outcomes were time to corneal clearing, optical quality (higher-order aberrations), and complications.

RESULTS

BCVA improved significantly in both groups, with faster recovery in Group B (0.24 ± 0.11 vs. 0.36 ± 0.14 logMAR at 6 months; p < 0.05). CCT decreased more rapidly in Group B (572.1 ± 27.5 µm vs. 590.2 ± 29.8 µm; p = 0.04). Peripheral ECD remained stable in Group A but showed a mild gain in Group B (p = 0.04). Group B achieved earlier corneal deturgescence (mean 8 ± 2 weeks vs. 12 ± 3 weeks). No eye in either group developed persistent edema, interface haze, or required rescue keratoplasty.

CONCLUSIONS

Adjunctive topical ripasudil after DWEK accelerates endothelial recovery, corneal deturgescence, and visual rehabilitation compared with DWEK alone, without compromising safety.