Descemet’s stripping only shows promise in some Fuchs’ patients
PARIS — For some patients, the use of a topical Rho kinase inhibitor following a Descemet’s stripping only procedure for Fuchs’ dystrophy “can be life-changing,” Kathryn Colby, MD, PhD, said at EuCornea 2019.
Colby, who is chair of the department of ophthalmology and visual sciences at the University of Chicago, has been interested in this line of research since 2013, even though the idea was not well received in the cornea community at the time, she said.
Colby reported recent research in which 29 eyes of 23 patients were enrolled, and stripping size varied from 4 mm to 5 mm × 6.5 mm. Mean follow-up was 15 months.
“Twenty-one patients who accounted for 27 eyes obtained and used topical ripasudil, a Rho kinase inhibitor approved for glaucoma in Japan,” Colby said. Use of ripasudil is off label, and patients must obtain and administer it themselves.
Twenty-five of 29 eyes cleared at an average of 7 weeks after surgery (86%), some as rapidly as 3 weeks. The four eyes that did not clear well went on to have uneventful endothelial keratoplasty.
Vision improved to 20/40 or better in 85% of eyes, with a mean endothelial cell count of 1,450 cells/mm2 and mean pachymetry of 595 µm.
“This represents an improvement over the results in our initial study from 2013 to 2015 where the average cell count was about a thousand, and it does suggest that Rho kinase inhibitor does have a positive effect,” Colby said.
About 80 cases so far have been published or spoken about, Colby said. In series done by Colby and colleagues and others, Descemet’s stripping only has been successful in 85% to 90% with average clearance time of 7 weeks, she said.
“The Rho kinase inhibitor that we used, ripasudil, appears to speed up the process, and others have suggested that it may turn nonresponders into responders and increase final cell count,” Colby said.
The manufacturer of ripasudil, Kowa, has submitted a phase 2 study to the FDA in the U.S., she said. – by Patricia Nale, ELS
Colby K. Outcomes of Descemet stripping only (DSO) supplemented with a topical rho kinase inhibitor for Fuchs dystrophy. Presented at: EuCornea; Sept. 13-14, 2019; Paris.
Disclosure: Colby reports no relevant financial disclosures.