Changes in corneal endothelial cell shape after treatment with one drop of ROCK inhibitor.

PURPOSE: We performed an investigation of the temporal impact on corneal endothelial cell (CEC) shape after ophthalmic instillation of one drop of the ROCK inhibitor, ripasudil. METHODS: Subjects comprised 32 healthy adult volunteers, each of whom instilled ripasudil in the right eye. CEC shape [defined as CEC density (CECD), coefficient of variation (CV), and hexagonal cell rate (6A)], central corneal thickness (CCT), intraocular pressure (IOP), and conjunctival hyperemia were evaluated before instillation (baseline) and at 15 min, 1 h, 2 h, and 4-6 h after instillation by non-contact specular microscopy and slit-lamp microscopy. The incidence of pseudo gutta was also assessed. RESULTS: The CECD (cells/mm2) significantly decreased after instillation as follows: 2661 cells/mm2 at baseline, 2578 cells/mm2 at 15 min, 2527 cells/mm2 at 1 h, 2575 cells/mm2 at 2 h, and 2613 cells/mm2 at 4-6 h. After instillation, CV significantly increased and 6A significantly decreased. Pseudo gutta appeared in 18 subjects (56.3%) after instillation. There was no difference in CCT before and after instillation. IOP significantly decreased after instillation. The most severe conjunctival hyperemia was observed at 15 min after instillation, but had nearly disappeared within 2 h. CONCLUSIONS: Pseudo gutta appeared in more than half of the subjects, and the CEC shape changed upon instillation of one drop of ripasudil; however, it recovered at 4-6 h after instillation. Therefore, these changes would not greatly impact clinical treatment. Similar to the presence of conjunctival hyperemia, changes in CEC shape occur at early stages after instillation of ripasudil.

A 23-Year-Old Woman with Sudden-Onset Blindness of the Right Eye.

A 23-year-woman was presented for sudden-onset monocular blindness. Branch retinal artery occlusion in the right eye and multiple brain embolism were detected. Trousseau syndrome due to bilateral ovarian cancer was diagnosed; no embolic events were observed after anticoagulant therapy and surgical resection.

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.

Bleb-like Finding Caused by Idiopathic Scleral Thinning in an Eye With Absolute Glaucoma.

PURPOSE: To evaluate a bleb-like finding in an eye with absolute glaucoma using anterior-segment optical coherence tomography (AS-OCT). METHODS: A 35-year-old woman complained of sudden-onset pain in the right eye. She had been diagnosed with keratitis at 1.5 years old and the onset of secondary glaucoma was identified at 13 years old. At the age of 26 years, transscleral contact diode laser cyclophotocoagulation therapy was performed, except for the upper quadrant, because scleral thinning was noted at that time. At the age of 35 years, she was blind in her right eye and corneal opacity and a bleb-like structure in the upper conjunctiva was seen with a slit-lamp examination. This bleb-like structure was removed surgically at bulbar exenteration, and the pathology was examined. RESULTS: AS-OCT showed a bleb-like internal structure with a single large empty space and thin scleral tissue and relatively thin walls with high optical density. Pathology indicated that the high optical density bleb wall was connective tissue. On AS-OCT, the internal surface of the empty space was very smooth, which matched the pathology. Histochemically, there were goblet cells, as in normal conjunctiva, but not in the conjunctiva over the aqueous space. CONCLUSIONS: AS-OCT images found that the intrableb structure was in good agreement with the pathology results; these conjunctival changes were very similar to those after a standard trabeculectomy.

Precise identification of filtration openings on the scleral flap by three-dimensional anterior segment optical coherence tomography.

PURPOSE: To elucidate the potential of three-dimensional anterior segment optical coherence tomography (3D AS-OCT) for identifying filtration openings where aqueous humor flows from the sclera into the subconjunctival space. METHODS: We used 3D AS-OCT and custom software to identify filtration openings, which were defined by pits and/or troughs in fluid-filled cavities in both horizontal and vertical rasters and corresponding C-scan images of scleral flap margin in the blebs. We measured bleb parameters, and at least three different reviewers surveyed the complete 3D images of the internal structure of the filtration blebs and associated findings. RESULTS: We identified filtration openings in 118 (95%) of 124 eyes. Among these 118 eyes, we found only a single filtration opening in 90 eyes (76%) and two or more filtration openings in the remaining 28 eyes (24%). Filtration openings were located in the middle third of the scleral flap margins in 57 eyes (63%) of the 90 eyes. The pattern of incision and sutures used for closure of the conjunctival flap affected the location of the openings, but additional laser suture lysis did not. In 6 (5%) of the 124 eyes, filtration openings could not be identified because of high reflectivity and/or elevated bleb wall (2 eyes), and no fluid-filled cavities because a sponge-like structure masked the filtration openings just above the scleral flap (4 eyes). CONCLUSIONS: 3D AS-OCT allows, in most cases, detailed evaluation of internal morphology of filtration blebs and precise identification of filtration openings on the scleral flap margins after trabeculectomy.