Additive Intraocular Pressure Lowering Effects of the Rho Kinase Inhibitor, Ripasudil in Glaucoma Patients Not Able to Obtain Adequate Control After Other Maximal Tolerated Medical Therapy

The aim of this study is to investigate the additive intraocular pressure (IOP)-lowering effects and safety of the selective Rho kinase inhibitor, 0.4% ripasudil, in patients with glaucoma not adequately controlled by other maximal tolerated medical therapies. We retrospectively reviewed 92 glaucoma patients who received ripasudil as an additive glaucoma treatment. In spite of receiving prior maximal tolerated medical therapies, all patients had uncontrolled glaucoma before receiving ripasudil. IOP was recorded at all follow-up dates. The study population consisted of 43 primary open-angle glaucoma (POAG), 28 normal-tension glaucoma (NTG), ten secondary glaucoma, seven exfoliation glaucoma, and four developmental glaucoma patients. After ripasudil administration, there was a significant decrease in the IOP. The mean pre-administration IOP and % IOP reduction at the last follow-up were 19.7 +/- A 4.9 mmHg and 6.5 +/- A 17.0% for POAG, 15.5 +/- A 2.0 mmHg and 2.3 +/- A 10.4% for NTG, 22.8 +/- A 8.3 mmHg and 19.1 +/- A 13.5% for secondary glaucoma, 22.5 +/- A 4.4 mmHg and 2.1 +/- A 14.5% for exfoliation glaucoma, and 20.2 +/- A 8.9 mmHg and 11.4 +/- A 23.1% for developmental glaucoma, respectively. Side effects led to ripasudil discontinuation in 13 patients, with five exhibiting an allergic reaction, six developing blepharitis, and two having a burning sensation. Use of ripasudil as an adjunctive therapy resulted in lowering of the IOP. Ripasudil was well tolerated. Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (26462689).