Intravitreal fasudil monotherapy for treatment of refractory diabetic macular edema: A prospective interventional case series.

R Nourinia, H Nouri, S-H Abtahi, S Nakao, J Eslamipour, E Gerami, H Ahmadieh

Journal: Journal francais d'ophtalmologie 2024;46(9):1055-1060

PMID: 37620196

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Suboptimal response to conventional treatments in refractory diabetic macular edema (rDME) encourages efforts to identify new therapeutic options.

PURPOSE

To evaluate the effect of three monthly intravitreal injections of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) in eyes with rDME.

METHODS

Ten eyes of 10 patients with DME unresponsive to at least six previous intravitreal bevacizumab (IVB) injections were recruited and underwent 3 consecutive monthly intravitreal injection of 0.025mg/0.05mL Fasudil. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated as functional and anatomical response indicators, respectively.

RESULTS

The mean age was 60.1±5.1 years (range, 53-68). Five cases responded to treatment, two with both anatomical and functional responses (reduction of CMT from 521 to 395 and from 390 to 301 microns and improvement of BCVA from 0.3 to 0.1 LogMAR and 0.6 to 0.4 LogMAR, respectively) and three with only functional improvement (0.7 to 0.4; 0.7 to 0.4; and 0.3 to 0.1 LogMAR). Of note, cases with no significant change in CMT showed morphologic improvement of the retinal microstructure to some extent. No adverse event was observed during the study period.

CONCLUSION

Monotherapy with intravitreal injection of ROCK inhibitors appears to have moderate visual benefits in eyes with DME refractory to IVB. Such effects may be functionally significant without obvious anatomical improvement.

Address: Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.; Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.; Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.; Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: [email protected].

DOI: 10.1016/j.jfo.2023.03.034

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MeSH Terms: Humans, Macular Edema, Diabetic Retinopathy, Intravitreal Injections, 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine, Middle Aged, Male, Female, Aged, Prospective Studies, Treatment Outcome, Protein Kinase Inhibitors, Visual Acuity, rho-Associated Kinases