Efficacy of ripasudil in reducing intraocular pressure and medication score for ocular hypertension with inflammation and corticosteroid

Abstract

Aim: To investigate the efficacy of ripasudil, a Rho kinase inhibitor, in reducing intraocular pressure (IOP) and medication scores of anti-glaucoma drugs in patients with ocular hypertension with inflammation and corticosteroid.

Methods: The study included 11 patients diagnosed with ocular hypertension with inflammation and corticosteroid, all of whom were prescribed ripasudil eye drops and followed up for at least 2y after the initiation of treatment. IOP was measured using a non-contact tonometer before enrollment and at each follow-up visit. The medication score of glaucoma eye drops was calculated for each patient.

Results: The mean IOP (26.4±2.9 mm Hg before treatment) significantly decreased after ripasudil therapy (13.7±3.3 mm Hg at 3mo) and remained stable in the low-teens during the 2-year follow-up period (P<0.0001). A significant decrease in the medication score was observed at 12mo or later after the initiation of ripasudil therapy (P<0.05). Both baseline medication scores and glaucomatous optic disc change rates were significantly higher in the five eyes that required glaucoma surgery during the 2-year observation period than the 10 eyes that did not require surgery.

Conclusion: Our results demonstrate the efficacy of ripasudil, in reducing IOP and the medication score over a 2-year treatment period in patients with ocular hypertension with inflammation and corticosteroid. Our findings also suggest that ripasudil could reduce the IOP in uveitic glaucoma patients with both lower baseline medication score and lower glaucomatous optic disc change rate.

Keywords: Rho kinase inhibitor; glaucoma; intraocular pressure; medication score; uveitis.

Figure 1. Effects of ripasudil on anti-inflammatory therapy for uveitis control

Data are shown excluding the five eyes that required glaucoma surgery. IMT: Immunomodulatory therapy.

Figure 2. Time course of intraocular pressure (IOP) after administration of ripasudil in all patients

A: Mean IOP±standard deviation is shown without dropouts who required glaucoma surgery; B: Rate of glaucoma surgery-free patients with uveitic glaucoma after ripasudil treatment. IOP changes from the baseline were analyzed using a one-way analysis of variance and Kruskal-Wallis multiple-comparison tests. ^cP<0.0001.

Figure 3. Subgroup analysis of causes of ocular inflammation with (glaucoma surgery) or without glaucoma surgery (medication only) after ripasudil treatment.

Figure 4. Time-dependent changes in medication score over 2y of follow-up after administration of ripasudil

Mean medication scores±standard deviation are shown as maximum amount of data without dropouts or missing data for all eyes (A) or eyes with medication group excluding the five eyes that required glaucoma surgery (B). Changes of medication scores from the baseline was analyzed using one-way analysis of variance and Kruskal-Wallis multiple-comparison tests. ^aP<0.05, ^bP<0.01.