Macsai Marian S, Shiloach Mira
Division of Ophthalmology, NorthShore University HealthSystem, Glenview, IL.
Cornea. 2019 May;38(5):529-534. doi: 10.1097/ICO.0000000000001883.
Fuchs corneal dystrophy (FD) is a common cause of endothelial keratoplasty. Recently, a series of FD cases treated with Descemet stripping only (DSO) demonstrated recovery of the central endothelium without transplantation of donor cells. Ripasudil, a rho kinase inhibitor, has been shown to promote corneal endothelial wound healing in animal models. This study prospectively evaluated the use of ripasudil in patients undergoing DSO for FD.
Enrolled patients underwent DSO with or without cataract surgery, performed by 1 surgeon. On the first postoperative day, patients were assigned to topical ripasudil 0.4% (Glanatec) 4 times a day for 2 months or no ripasudil and followed up monthly for the first 6 months and then at 9 and 12 months after surgery. Endothelial cell density (ECD) and pachymetry were evaluated at each postoperative visit.
Eighteen patients were enrolled, including 8 women and 1 man in each group. Overall, patients who underwent DSO with ripasudil recovered vision more quickly (4.6 vs. 6.5 weeks, P < 0.01). In addition, the ripasudil group had a statistically significantly higher average ECD at 3, 6, and 12 months. The patients in the DSO observation group had a 10% decrease in peripheral ECD when comparing counts before surgery with counts 12 months after surgery (P < 0.05). In the DSO ripasudil group, there was no significant difference between peripheral ECD at preoperative baseline versus 12 months after surgery.
DSO with topical rho kinase inhibitors may be an alternative treatment for patients with FD and a peripheral ECD greater than 1000 cells/mm.
富克斯角膜营养不良（FD）是内皮角膜移植的常见病因。最近，一系列仅采用后弹力层剥除术（DSO）治疗的FD病例显示，中央内皮细胞得以恢复，而无需移植供体细胞。Ripasudil是一种Rho激酶抑制剂，已证实在动物模型中可促进角膜内皮伤口愈合。本研究前瞻性评估了Ripasudil在接受DSO治疗FD患者中的应用。
纳入的患者接受了由1名外科医生实施的伴有或不伴有白内障手术的DSO。术后第一天，患者被分配为每天4次局部使用0.4%的Ripasudil（Glanatec），持续2个月，或不使用Ripasudil，并在术后前6个月每月随访，然后在术后9个月和12个月进行随访。每次术后随访时评估内皮细胞密度（ECD）和角膜厚度。
共纳入18例患者，每组包括8名女性和1名男性。总体而言，接受DSO联合Ripasudil治疗的患者视力恢复更快（4.6周对6.5周，P<0.01）。此外，Ripasudil组在3个月、6个月和12个月时的平均ECD在统计学上显著更高。将DSO观察组患者手术前与术后12个月的外周ECD计数进行比较，外周ECD下降了10%（P<0.05）。在DSO联合Ripasudil组中，术前基线外周ECD与术后12个月之间无显著差异。
对于外周ECD大于1000个细胞/mm²的FD患者，局部使用Rho激酶抑制剂的DSO可能是一种替代治疗方法。
