Additive Intraocular Pressure Lowering Effects of Ripasudil in Patients with Primary Open Angle Glaucoma and Ocular Hypertension

Abstract

Introduction: Glaucoma is one of the leading causes of irreversible blindness worldwide. Among the affected ones, approximately 50% are not aware of it, because of its asymptomatic nature, especially in the early stages. Ripasudil Hydrochloride Hydrate is a novel drug, being the Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor eye drop that increases conventional aqueous outflow through the trabecular meshwork and Schlemm’s canal and thus lowers the intraocular pressure.
Material and Methods: This prospective study included the first 150 consecutive eyes in patients of uncontrolled glaucoma with IOP > 21 mmHg despite maximal topical anti-glaucoma medications in at least one eye and aged eighteen or above. The patients with neovascular glaucoma, closed or barely open anterior chamber angle or with history of ocular surgery including refractive surgery were excluded. The purpose and nature of the study were explained in detail, and informed consent was obtained from all patients.
Results: This study included 115 patients with 150 affected eyes. The mean age of patients in this series was 43.6 years with a range of 24-73 years. Right eye was affected in 47, left in 33 patients and the remaining 35 patients had bilateral involvement. The mean pachymetry was 521.13 µm in right eye and 523.53 µm in left eye and the mean cup disc ratio was 0.8 and 0.7 in right and left eye respectively. The mean baseline intraocular pressure in our series was 18.60 mmHg +- 7.60 mmHg. The mean IOP at six month follow up visit (final follow-up) was 11.83mmHg +- 4.45, which was statistically significant. The mean reductions in IOP at one month was 12.64mmHg, at 3 months follow up 12.07mmHg.
Conclusion: The results of our study implies that ripasudil is a favourable anti glaucoma drug that can lower intraocular pressure. The additive pressure lowering effects of ripasudil in addition to existing maximal therapy can be because of different mechanism of action, it can delay or evade surgery in glaucoma. Transient conjunctival hyperaemia, not necessitating discontinuation was the most common complication in this series.