Purpose: Ripasudil is a class of drug which alters the trabecular meshwork to increase the aqueous outflow and has been shown to be effective in pseudoexfoliative glaucoma (PXF G). This study aimed at assessing the efficacy and safety profile of ripasudil as an adjunct treatment in patients with PXF G at maximal tolerated antiglaucoma medications. Methods: In this prospective, interventional study, 40 patients with PXF G were enrolled between May 2021 and Jan 2022. Ripasudil 0.4% was started as an adjunctive drug to the ongoing antiglaucoma medications. On follow-up visits at 1, 3, and 6 months, the visual acuity, intraocular pressure (IOP), anterior segment, and fundus findings were evaluated. The premedication and postmedication IOP values were compared by paired t-test, and a P-value <0.05 was considered statistically significant. Results: Average age at recruitment was 60.02 ± 8.74 years. Baseline premedication IOP was 25.375 ± 3.276 mmHg. IOP reduction at 6 months was found to be statistically significant in all patients, with the maximal response being 24.13%. Also, 87.5% (35/40) of patients reached target IOP or even lower IOP at the end of study. There was no statistically significant association between the PXF grade and IOP. However, the grade of inferior iridocorneal angle pigmentation was found to be higher in eyes with elevated IOP (P < 0.05). Only three patients developed conjunctival hyperemia as an adverse reaction, which was mild and transient. Conclusion: Ripasudil showed additional IOP-lowering effect with other antiglaucoma medications and exhibited no significant side effects.

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Results:The mean SE, KM and CCT of the patients under the study were (-) 0.47 ± 2.26,43.79 ± 1.18D and 528.41 ± 19.1µm. Mean CCT was higher in age group C (46 to 60 yrs) than other groups (p = 0.008) but no impact was found on increasing age after regression analysis. CCT was not affected by gender (p = 0.168). Mean CCT for Myopic was found to be 522.87±18.03µm which was lower compared to in Hypermetropic (536.39 ±17.753µm) (p = <0.001). There was a positive correlation between CCT and SE (r = 0.520, p = <0.001). However KM showed negative correlation with CCT (r = -0.288, p = <0.001). Conclusion:From above study we concluded that CCT was related to age, refractive status and keratometry but not to sex.