Although Descemet stripping only is a cost-effective and less complicated procedure that eliminates the risk of tissue rejection for Fuchs’ dystrophy (FD) patients, the unpredictable outcomes hampers its widespread use within this patient population. To solve this problem, researchers set out to find a therapy that can promote corneal endothelial proliferation—and they discovered rho-kinase (ROCK) inhibitors, which can aid in the repopulation of the human corneal endothelium. A new study shows topical application of the ROCK inhibitor ripasudil (Glanatec) for two months after Descemet stripping only can help FD patients achieve recovered 20/40 vision.

Researchers at the NorthShore University HealthSystem in Glenview, IL, enrolled 18 patients in this study, assigning nine to the Descemet stripping–only group and nine to the descemet stripping with topical ripasudil group. Patients in the latter group were prescribed topical ripasudil 0.4% four times a day for two months. All participants were followed monthly for the first six months and then at nine and 12 months after surgery. The researchers assessed endothelial cell density (ECD) and pachymetry at each visit.

They discovered the use of topical ripasudil led to more rapid visual recovery, at 4.6 weeks compared with 6.5 weeks for the observation group. They also noticed the ROCK inhibitor group had higher central ECD at 12 months (1,086cells/mm2 vs. 736cells/mm2), and less loss of peripheral ECD (1,142cells/mm2 vs. 1,233 cells/mm2) compared with the Descemet stripping–only with no topical ripasudil group.

While ripasudil is commercially available in Japan for the treatment of glaucoma, it remains an investigational drug in the United States.

The study holds significant promise for FD patients, but it leaves many questions unanswered. The researchers do not know how long the corneas will remain clear with this treatment, and the small sample size limits their ability to recommend its broad use among all FD patients. Future treatments will require a personalized approach and will depends on the clinical presentation, the researchers said in the study.

“For example, patients with FD with no symptoms will be treated with observation, whereas patients with a peripheral ECD greater than 1,000cells/mm2 may be treated with DSO and topical ripasudil,” they wrote in the study. “DSO with topical ripasudil may be the treatment of choice early in the disease process, reserving DMEK for patient who present with more advanced disease states.”

Macsai MS, Shiloach M. Use of topical rho kinase inhibitors in the treatment of fuchs dystrophy after descemet stripping only. Cornea. February 1, 2019. [Epub ahead of print].