Honeycomb epithelial oedema due to ripasudil: clinical, optical coherence tomography and histopathological correlation

Abstract

A male in his 50s, who had undergone Descemet’s stripping automated endothelial keratoplasty (DSAEK) for corneal oedema following irido-corneal-endothelial syndrome and glaucoma drainage device surgery for secondary glaucoma presented with gradual decreased vision. The patient was on ripasudil 0.4% for the past 4 months prior to the presentation. Honeycomb epithelial oedema was seen with vesicles and intraepithelial microcyst formation which were also noted on anterior segment optical coherence tomography (OCT) and histopathology, that co-related with the slit-lamp findings. The patient underwent repeat DSAEK and had a good outcome. While the clinical features and OCT findings have been reported earlier, the histopathological features have not been reported.

ROCK Inhibitors in Corneal Diseases and Glaucoma—A Comprehensive Review of These Emerging Drugs

“…There have been some case reports of a further adverse effect of honeycomb/reticular epithelial oedema [35,45,46] not reported in previously discussed larger clinical trials. This effect is usually transient, but in one case the patient required a repeat corneal graft procedure to improve visual function [45].…”

“…The main reasons for discontinuing ripasudil were usually blepharitis and symptoms such as pruritis and eyelid redness, rather than conjunctival hyperemia [44]. There have been some case reports of a further adverse effect of honeycomb/reticular epithelial oedema [35,45,46] not reported in previously discussed larger clinical trials. This effect is usually transient, but in one case the patient required a repeat corneal graft procedure to improve visual function [45].…”