What question did this study set out to answer?

To evaluate the effects of topical ripasudil on Schlemm’s Canal morphology in glaucoma patients.

February 23, 20260 citationsOpen Access

Possible Effects of Topical Rho-Kinase Inhibitor on Schlemm’s Canal Morphology Parameters

AMAysha Siddika MuktaShimane University ATAika TsutsuiShimane University THTeruhiko HamanakaJapanese Red Cross Medical Center

Puntos clave

To evaluate the effects of topical ripasudil on Schlemm’s Canal morphology in glaucoma patients.
Included 95 Schlemm’s Canal specimens from patients undergoing trabeculectomy.
Patients were divided into groups based on ripasudil treatment—received standard medications or medications plus ripasudil.
SC morphology parameters assessed via TBM staining, including total length and area measurements.
Statistical comparisons utilized unpaired t-tests and multiple regression analysis.
The ripasudil group had significantly longer total SC length (302.5 µm) compared to the control group (273.0 µm).
Opened SC area was larger in the ripasudil group (2689 µm²) versus the control (1881 µm²).
TBM-negative opened SC area was also significantly greater in the ripasudil group (716 µm² vs 305 µm²), highlighting morphological benefits.

Resumen

Background: To evaluate the effects of preoperative topical ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, on Schlemm’s canal (SC) morphology in patients with primary open-angle glaucoma (POAG). Methods: This study included 95 SC specimens obtained during trabeculectomy from 95 patients with POAG. Based on preoperative treatment, patients were divided into two groups: ripasudil (–) group (n = 68) receiving four topical medications FP receptor agonist, β-blocker, carbonic anhydrase inhibitor (CAI), and α2 agonist, and ripasudil (+) group (n = 27) receiving the same four medications plus ripasudil. SC morphology parameters were assessed in thrombomodulin (TBM)-stained sections, including length parameters TBM-positive/negative and opened/closed SC lengths and area parameters TBM-positive/negative and opened SC areas. Between-group comparisons were performed using unpaired t-tests, and multiple regression analysis was conducted to adjust for age, gender, preoperative intraocular pressure (IOP), and oral CAI use. Results: The ripasudil (+) group had significantly longer total SC length (TSC: 302.5 µm) than the ripasudil (–) group (273.0 µm, p = 0.023). Among area parameters, the ripasudil (+) group showed significantly larger opened SC area (OSC-A: 2689 µm² vs. 1881 µm², p = 0.008) and TBM-negative opened SC area (NOSC-A: 716 µm² vs. 305 µm², p = 0.001), whereas TBM-positive opened SC area (POSC-A) was not significantly different between groups (2001 µm² vs. 1575 µm², p = 0.096). After multivariate adjustment, ripasudil use remained significantly associated with longer TSC (p = 0.011) and larger OSC-A (p = 0.014) and NOSC-A (p = 0.001). Conclusions: Preoperative use of topical ripasudil was associated with preservation of SC lumen morphology, particularly in regions lacking SC endothelium. These findings provide a theoretical basis for therapeutic strategies employing ROCK inhibitors to maintain SC morphology and function.

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