Efficacy of Ripasudil as a Second-line Medication in Addition to a Prostaglandin Analog in Patients with Exfoliation Glaucoma: A Pilot Study.

OBJECTIVE: This study aimed to assess the intraocular pressure (IOP)-lowering effects of ripasudil, a Rho kinase inhibitor, as a second-line medication in patients with exfoliation glaucoma.

METHODS: This retrospective cohort study included patients with exfoliation glaucoma who received ripasudil as the second-line drug in addition to prostaglandin analogs, and were followed-up for at least 5 months. Twenty-seven eyes of 16 patients were enrolled; the mean (±standard deviation) age was 76.1 ± 7.2 years (range 63-91 years). Baseline IOPs were the averages of three IOP measurements performed before ripasudil treatment. Statistical analyses used the paired t test with the Bonferroni correction. Relevant background factors were analyzed via stepwise, multiple regression analysis.

RESULTS: The mean (±standard deviation) IOP levels prior to commencement of ripasudil, 1-2 months later, and 5-6 months later were 16.2 ± 2.1, 14.7 ± 2.8, and 13.1 ± 2.6 mmHg, respectively. These levels differed significantly (p = 0.00019 for 0 versus 1-2 months, 0.00087 for 1-2 vs. 5-6 months, and <0.00001 for 0 vs. 5-6 months). Stepwise multiple regression analysis on data from all 27 eyes showed that the change in IOP at 5-6 months was associated with the treatment time with prostaglandin analogs and age, but not with baseline IOP, the severity of the visual field defect, the timing of IOP measurement, or pseudophakic status.

CONCLUSIONS: Ripasudil significantly lowered IOP in patients with exfoliation glaucoma, and the effect thereof increased over time within 5 months.