Ripasudil's paradox: bullous keratopathy with honeycomb twist

Area of Science:

• Ophthalmology
• Corneal Diseases
• Pharmacology

Background:

• Bullous keratopathy can arise from various causes, including intraocular lens complications.
• Ripasudil, a Rho-kinase inhibitor, is used to treat glaucoma and ocular hypertension.
• Corneal edema and keratopathy are potential side effects of ocular medications.

Observation:

• A male patient developed bullous keratopathy secondary to an anterior chamber intraocular lens.
• The condition was complicated by superimposed honeycomb keratopathy while using ripasudil 0.4%.
• Clinical presentation included generalized microcystic and central macrocystic epithelial edema with a honeycomb pattern.

Findings:

• Discontinuation of ripasudil led to the resolution of the honeycomb keratopathy.
• Pre-existing microcystic corneal edema persisted after ripasudil cessation.
• This suggests a complex and potentially paradoxical effect of ripasudil on corneal endothelium.

Implications:

• Early identification of ripasudil-induced keratopathy is critical for effective management.
• Vigilant monitoring is necessary, especially when ripasudil is prescribed by different clinicians.
• Understanding ripasudil's corneal effects is essential for patient safety and treatment strategies.