Favorable effect of ripasudil use on surgical outcomes of microhook ab interno trabeculotomy

Graefes Arch Clin Exp Ophthalmol. 2023 Sep;261(9):2603-2610. doi: 10.1007/s00417-023-06040-1. Epub 2023 Mar 31.


Purpose: We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes.

Method: The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21 mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1 year.

Result: Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01).

Conclusion: The patients who took ripasudil showed a favorable 1-year outcome of µTLO.

Keywords: Ab interno trabeculotomy; Propensity score analysis; Rho kinase inhibitor; Ripasudil hydrochloride hydrate; Schlemm’s canal surgery.

MeSH terms

  • Glaucoma* / drug therapy
  • Glaucoma* / surgery
  • Humans
  • Intraocular Pressure
  • Retrospective Studies
  • Trabeculectomy*
  • Treatment Outcome


  • K-115