Descemetorhexis Without Grafting for Fuchs Endothelial Dystrophy-Supplementation With Topical Ripasudil.

Abstract

PURPOSE:

To report the safety and efficacy of descemetorhexis without grafting as a primary intervention in Fuchs dystrophy, and the use of a ROCK inhibitor, ripasudil as a salvage agent in failing cases.

METHODS:

Twelve eyes of 11 patients underwent central descemetorhexis not exceeding 4 mm. All had Fuchs dystrophy-producing visual symptoms, requesting intervention. Exclusion criteria were a peripheral endothelial cell count <1000 and central edema. Corneal clearance and visual parameters were recorded monthly until corneal clearance was observed, then at intervals of 6 months. Cases failing to clear by month 2 were considered for salvage treatment. This consisted of treatment with 1 of 2 formulations of Rho-associated kinase inhibitor eye drops. Endothelial keratoplasty was planned as the final salvage procedure in unsuccessful cases.

RESULTS:

Nine of 12 eyes cleared spontaneously between 2 and 6 months. One eye failed to clear by month 5 and topical Y-27632 was administered, without success. Endothelial keratoplasty was performed. In 2 eyes, healing stalled at 3 and 2 months. In both cases, topical ripasudil administered 6 times a day for 2 weeks resulted in complete corneal clearance. In cases achieving corneal clearance, best spectacle corrected visual acuity improved from a mean of 0.26 to 0.125 (logMAR) with subjective improvement in quality of vision.

CONCLUSIONS:

In Fuchs dystrophy with visual degradation due to central guttae, descemetorhexis without grafting is a viable procedure for visual rehabilitation. Careful patient selection is required, but the advent of topical ripasudil as a salvage agent suggests that a broader application of the surgery may be possible. Further study into the use of this agent is now needed.

• Authors: Gregory Moloney, Constantinos Petsoglou, Matthew Ball, Yves Kerdraon, Roland Höllhumer, Natasha Spiteri, Simone Beheregaray, Judith Hampson, Mario DʼSouza, Raj N Devasahayam
• Journal: Cornea (Cornea) Vol. 36 Issue 6 Pg. 642-648 (Jun 2017) ISSN: 1536-4798 [Electronic] United States
• PMID: 28476048 (Publication Type: Journal Article)

Chemical References

• Isoquinolines
• K-115
• Ophthalmic Solutions
• Sulfonamides
• rho-Associated Kinases

Topics

• Administration, Topical
• Adult
• Aged
• Cell Count
• Combined Modality Therapy
• Descemet Membrane (surgery)
• Descemet Stripping Endothelial Keratoplasty
• Female
• Follow-Up Studies
• Fuchs' Endothelial Dystrophy (drug therapy, physiopathology, surgery, therapy)
• Humans
• Isoquinolines (therapeutic use)
• Male
• Middle Aged
• Ophthalmic Solutions
• Prospective Studies
• Refraction, Ocular (physiology)
• Sulfonamides (therapeutic use)
• Visual Acuity (physiology)
• rho-Associated Kinases (antagonists & inhibitors)