Topical Ripasudil as First Line Treatment for Ocular Hypertension in Uveitis Cases: AnAnalytic Study

Abstract

Introduction: Uveitis can directly or indirectly lead to ocular hypertension which can lead to glaucoma. Ripasudil has a different mechanism of action than other anti-glaucoma medications available commercially and in contrary to these drugs, ripasudil also has anti-inflammatory properties providing an upper edge over other intraocular pressure lowering drugs. In addition to primary glaucoma, these new Rho kinase associated inhibitors can provide satisfactory results in glaucoma with secondary pathologies. Aim: To study the role of ripasudil as first line treatment for ocular hypertension in uveitis cases. Materials and Methods: A prospective randomised study comprising 40 patients of Ocular Hypertension (OHT) associated with uveitis was conducted in the Outpatient Department (OPD) of Ophthalmology at a tertiary care hospital in North India from October 2020 to January 2021. The diagnosis of uveitis was made clinically with detailed medical history and slit lamp biomicroscopic examination. All the diagnosed patients were started with topical ripasudil hydrochloride hydrate 0.4% eye drops twice daily along with anti-inflammatory medications. Intraocular Presure (IOP) was recorded after 4 weeks and 12 weeks at 8 am, 10 am and 4 pm. Effectiveness of the drugs was calculated in terms of mmHg fall in mean intraocular pressure using t-test and p-values. Results: Out of 40 patients with uveitis associated OHT, 20caseswere inflammation related (mean age was 56.2±16.3years,13 males, 7 females) and 20 cases were categorised as corticosteroid induced (mean age was 58.9±15.69 years, 14 males, 6 females). At 12 weeks there was 5.67±0.59 mmHg fall in IOP (22.70%) in inflammation related OHT and there was 6.37±0.07 mmHg fall in IOP (25.34%) in corticosteroid related OHT. There was statistically significant fall in IOP (p-value=0.001). Conclusion: This study demonstrated that topical ripasudil hydrochloride hydrate 0.4% eye drops is effective in lowering the IOP, also there were no side effects, so it is safe and well-tolerated. So, ripasudil can provide a safe and effective alternative for lowering of IOP among uveitis related OHT.

The Application of Rho Kinase Inhibitors in the Management of Glaucoma

“…The study enrolled 332 eyes and found that the IOP decreased statistically significantly in all three groups but was more remarkable in UG and SG than EG, which the author thought to be related to higher baseline IOP levels in UG and SG. The finding suggested that ripasudil is safe and effective in IOP-lowering for secondary glaucoma [ 59 , 60 ]. A recent small-scale study that enrolled 16 patients also found that post-trabeculectomy use of ripasudil on UG patients could significantly reduce IOP and lower the need for bleb revision and suture lysis [ 61 ].…”