Late-Onset Ocular Hypotensive Effect of Ripasudil on Primary Open-Angle Glaucoma.

Purpose: We evaluated the late-onset ocular hypotensive effect of ripasudil after long-term administration in real-world clinical data and investigated its associated factors in primary open-angle glaucoma (POAG).

Patients and methods: We reviewed the clinical patients with POAG who newly started ripasudil without changes of treatment. Enrolled eyes were assigned to two groups: positive group with the late-onset effect and negative group. Eyes that show the late-onset effect 6 months after starting ripasudil were defined as positive. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the late-onset effect.

Results: We enrolled 74 eyes of 74 patients with POAG (age, 67.5 ± 10.9 years; mean deviation, -11.2 ± 5.9 dB) and followed them for 14.2 ± 5.0 months. Among them, 12 (16.2%) eyes were assigned to the positive group. Retinal nerve fiber layer (RNFL) thickness (73.4 ± 12.9 vs 64.0 ± 9.8 μm, P = 0.04) and primary IOP (18.8 ± 4.1 vs 15.8 ± 4.3 mmHg, P = 0.01) before starting ripasudil were higher in the positive group than in the negative group. The late-onset effect was associated with higher IOP (OR, 1.22; 1.01-1.48) and thicker RNFL (2.76; 1.15-6.63).

Conclusion: Some patients with POAG showed the late-onset IOP-lowering effect of ripasudil, and its associated factors were higher IOP and thicker RNFL. The addition of ripasudil may offer potential benefits particularly for early-stage glaucoma with thicker RNFL.