Topical ROCK inhibition accelerates recovery after Descemetorhexis Without Endothelial Keratoplasty (DWEK) in Fuchs endothelial corneal dystrophy: a prospective comparative clinical trial

Clinical Snapshot

Key Findings

• P Value: p < 0.05 for BCVA difference, p = 0.04 for CCT difference

• Effect Size: 0.12 logMAR better BCVA in ripasudil group (0.24 ± 0.11 vs 0.36 ± 0.14)

• Primary Outcome: BCVA improved significantly in both groups with faster recovery in ripasudil group

• Nnt Or Sensitivity: Not calculable from available data - would require individual patient outcomes

• Confidence Interval: Not reported

Clinical Application

Requires surgical expertise in DWEK technique and access to topical ripasudil DWEK is performed in Australian tertiary centres. Ripasudil not currently PBS-listed but available through Special Access Scheme. Would require TGA approval for this indication Patients with mild-to-moderate FECD undergoing cataract surgery who are candidates for DWEK procedure

Abstract

PURPOSE: To compare the clinical efficacy and recovery kinetics of Descemetorhexis Without Endothelial Keratoplasty (DWEK) performed with and without adjunctive topical ripasudil 0.4% in eyes with Fuchs endothelial corneal dystrophy (FECD). SETTING: Cornea and Refractive Surgery Services, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India. DESIGN: Prospective, randomized, interventional, comparative clinical study. METHODS: Twenty-four eyes with mild-to-moderate FECD underwent phacoemulsification with a standardized 4-mm central DWEK and were randomized to DWEK-alone (Group A) or DWEK + topical ripasudil 0.4% four times daily for eight weeks (Group B). Primary outcomes were changes in best-corrected visual acuity (BCVA, logMAR), central corneal thickness (CCT), and peripheral endothelial cell density (ECD) over 6 months. Secondary outcomes were time to corneal clearing, optical quality (higher-order aberrations), and complications. RESULTS: BCVA improved significantly in both groups, with faster recovery in Group B (0.24 ± 0.11 vs. 0.36 ± 0.14 logMAR at 6 months; p < 0.05). CCT decreased more rapidly in Group B (572.1 ± 27.5 µm vs. 590.2 ± 29.8 µm; p = 0.04). Peripheral ECD remained stable in Group A but showed a mild gain in Group B (p = 0.04). Group B achieved earlier corneal deturgescence (mean 8 ± 2 weeks vs. 12 ± 3 weeks). No eye in either group developed persistent edema, interface haze, or required rescue keratoplasty. CONCLUSIONS: Adjunctive topical ripasudil after DWEK accelerates endothelial recovery, corneal deturgescence, and visual rehabilitation compared with DWEK alone, without compromising safety.