Rho-Associated Kinase Inhibitor Eye Drops in challenging cataract surgery

PURPOSE: To report the impact of Rho-Associated Kinase Inhibitor Eye Drops in cases of cataract surgery performed in severe Fuchs’ endothelial corneal dystrophy (FECD). OBSERVATIONS: A patient affected by FECD stage II underwent femtosecond laser-assisted cataract surgery (FLACS), developed postsurgical corneal failure and was scheduled for endothelial keratoplasty. Compassionate treatment with Rho-Associated Kinase Inhibitor Eye Drops 4 times per day was started. A significant improvement in visual acuity and corneal failure was recorded. Thereafter, other two patients affected by FECD stage II were prophylactically treated with Rho-Associated Kinase Inhibitor Eye Drops 4 times per day for three months before FLACS with good visual and clinical outcome. CONCLUSIONS AND IMPORTANCE: These cases expand upon the reported effects of rho-associated kinase inhibitor Ripasudil in the FECD, suggesting a role as adjuvant medical therapy in patients advised for intraocular surgery to improve endothelial function and reduce the risk of pseudophakic bullous keratopathy (PBK).