Experience of Using Rho Kinase Inhibitor Eye Drops in Corneal Edema at Tertiary Care Hospital in Thailand

Purpose: This study aimed to evaluate the experience of using Rho kinase inhibitor eye drops in corneal edema. Setting/Venue: Thammasat University Hospital, Thailand Methods: This retrospective longitudinal cohort study included patients with corneal edema treated with topical ripasudil. Clinical data were collected from medical records, including diagnosis, demographic characteristics, dosage regimen, and outcomes such as visual acuity (VA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell count (EEC), coefficient of variation (CV), and percentage of hexagonal cells (%Hexa). Patients were followed across multiple visits (Visit 0-5). Subgroup analyses were performed according to underlying etiologies. Results: 46 eyes of 46 patients were selected, including 15 eyes of Pseudophakia bullous keratopathy (PBK)(32.6%), 14 eyes of Fuchs endothelial corneal dystrophy (FECD)(30.4%), 8 eyes of Corneal decompensation due to multiple surgeries(17.4%), 4 eyes of Descemet membrane detachment(8.7%), 3 eyes of Graft rejection(6.5%) and 2 eyes of Corneal endotheliitis (4.3%). An average age was 68.8 years (range 20-89 years). Co-morbidities were glaucoma in 19 eyes (41.3%). Baselines were VA (logMar 1.35), IOP (13.8), CCT (635.7μm), EEC (1271 cells), CV (40.4) and %Hexa (59.2%). At first visit (mean 37 days), clinical showed as VA (logMar 1.31), IOP (13.3), CCT (593.2μm), EEC (2,395 cells), CV (37), %Hexa (58.1%). The results demonstrated a statistically significant improvement in visual acuity from Visit 2 to Visit 5 (p = 0.015), indicating the potential of Rho kinase inhibitors to enhance visual function over time. Additionally, there was a notable decrease in central corneal thickness (CCT) across visits, suggesting a therapeutic effect of the treatment on corneal integrity. Although intraocular pressure (IOP) showed no statistically significant differences, a slight trend toward decreasing IOP was observed. Endothelial cell count (EEC) analysis indicated a trend of increasing values, particularly from Visit 0 to Visit 4, while the coefficient of variation (CV) demonstrated a decrease over the same period. However, the percentage of hexagonal cells (%Hexa) did not show significant changes, although there was a slight upward trend. Overall, the clinical response rate was promising, with 84.6% of patients demonstrating improvement from Visit 0 to Visit 5. While some patients experienced regression, the majority exhibited positive outcomes, highlighting the potential of Rho kinase inhibitors as an effective treatment modality for various corneal diseases. Conclusions: Rho kinase inhibitor eye drops may have role for treatment of corneal edema; corneal thickness was trending down in 1-3 months and stable at 6 months. Corneal endotheliitis, PBK and Corneal decompensation due to multiple surgeries showed good response. Drug tolerance and adverse effects should be observed.