Intravitreal fasudil combined with bevacizumab for treatment of refractory diabetic macular edema; a pilot study

Abstract

Purpose: To evaluate the effect of intravitreal injection of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) combined with intravitreal bevacizumab (IVB) on refractory diabetic macular edema (DME).

Methods: This prospective, interventional case series included 15 eyes of 15 patients with DME unresponsive to previous IVB injections. Eligible eyes underwent intravitreal injection of 0.025 mg Fasudil and 1.25 mg bevacizumab. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before and 4 weeks after treatment.

Results: Mean age was 64.6±7.3 (range, 49-79) years and mean number of previous IVB injections was 2.8. Mean pre-injection BCVA was 0.84±0.35 LogMAR, which was improved to 0.49±0.29 LogMAR four weeks after intervention (P=0.003). Mean CMT was decreased from 448±123 µm before treatment, to 347±76 µm at four weeks (P=0.001); no adverse event was observed during the study period.

Conclusion: Intravitreal ROCK inhibitors seem to entail structural and visual benefits in eyes with DME refractory to IVB monotherapy.

Keywords: Angiogenesis; Diabetic Macular Edema; Rho Kinase.

Figure 1

Optical coherence tomography images of three patients (A, B and C) show significant reduction of central macular thickness (CMT) one month after intravitreal injection of bevacizumab and Fasudil. CMT before treatment (top images) was 559, 516 and 455 μm decreasing to 281, 344 and 330 μm one month after treatment (lower images) in patients A, B and C, respectively.