Abstract
The current study aimed to address whether ripasudil, a Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor developed to treat glaucoma and ocular hypertension (OH), improves diabetic macular edema (DME) since it is known that ROCK upregulates vascular endothelial growth factor. We retrospectively investigated the foveal thickness (FT) measured by spectral-domain optical coherence tomography, visual acuity (VA), and intraocular pressure (IOP) in 12 eyes with DME that received ripasudil treatment for primary open-angle glaucoma or OH and compared them with 14 eyes that received no treatment. One month after ripasudil therapy, the mean FT decreased significantly from 439 ± 72 µm to 395 ± 62 µm (P = 0.003); this change was significantly different from that in the controls, in which the mean FT increased by 1 ± 39 µm (P = 0.01). Ripasudil also caused a significant decrease in IOP from 17.3 ± 5.2 mmHg to 14.6 ± 4.0 mmHg (P = 0.02); this change was significantly greater than that in the controls, in which IOP changed by 0.0 ± 1.6 mmHg (P < 0.008). There was no significant difference in the VA changes between groups. Our results suggested that ripasudil may have positive effects on both IOP and DME.
Highlights
Diabetic macular edema (DME) is the major cause of visual loss in patients who are of working age[1]
Previous studies have reported that a combination therapy of bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) and a Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor intravitreal injection was effective in eyes with severe diabetic macular edema (DME) that were refractory to anti-vascular endothelial growth factor (VEGF) therapy[15,16]
There were no significant differences between the groups with respect to baseline foveal thickness (FT) (439 ± 72 μm vs. 402 ± 54 μm), baseline logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) (0.39 ± 0.26 vs. 0.29 ± 0.37, 20/49 vs. 20/38 Snellen equivalent), baseline intraocular pressure (IOP) (17.3 ± 5.2 mmHg vs. 11.7 ± 2.9 mmHg), duration of diabetes, or hemoglobin A1c (HbA1c) level
Summary
Diabetic macular edema (DME) is the major cause of visual loss in patients who are of working age[1]. A recent meta-analysis that included 22,896 patients with diabetes showed that the prevalence of DME was 6.81%2. Intravitreal injections of anti-VEGF drugs have been gaining in popularity for treating DME, and many studies have investigated the effects of anti-VEGF drugs on DME4–8. Ripasudil (Glanatec Ophthalmic Solution 0.4%, Kowa Company, Ltd., Japan) is the first ophthalmic solution using a Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor developed to treat glaucoma and ocular hypertension (OH) in Japan[9,10,11]. Previous studies have reported that a combination therapy of bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) and a ROCK inhibitor (fasudil) intravitreal injection was effective in eyes with severe DME that were refractory to anti-VEGF therapy[15,16]. We showed the effect of ripasudil on DME in patients who had glaucoma or OH
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