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Open Angle Glaucoma: Treatment

Open Angle Glaucoma: Treatment

In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...

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Full-Circle Cauterization of Limbal Vascular Plexus for Surgically Induced Glaucoma in Rodents

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

Aysha Siddika Mukta¹, Aika Tsutsui¹, Teruhiko Hamanaka²

¹Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan.

|February 27, 2026

Summary

Preoperative topical ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, was associated with improved Schlemm's canal (SC) morphology in primary open-angle glaucoma (POAG) patients. This suggests ROCK inhibitors may help maintain SC structure and function.

Keywords:

Rho-associated protein kinase inhibitor Schlemm’s canal morphology aqueous humor outflow primary open-angle glaucoma ripasudil trabecular meshwork

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Area of Science:

Ophthalmology
Glaucoma Research
Cell Biology

Background:

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
Schlemm's canal (SC) plays a crucial role in aqueous humor outflow and maintaining intraocular pressure (IOP).
Dysfunction of SC morphology is implicated in POAG pathogenesis.

Purpose of the Study:

To investigate the impact of preoperative topical ripasudil on Schlemm's canal (SC) morphology in patients with POAG.
To assess whether ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, influences SC length and area parameters.
To provide a potential therapeutic rationale for using ROCK inhibitors in glaucoma management.

Main Methods:

A retrospective analysis of 95 SC specimens from POAG patients undergoing trabeculectomy.
Patients were categorized into two groups: those receiving standard topical medications and those additionally treated with topical ripasudil.
SC morphology was evaluated using thrombomodulin (TBM)-stained sections, analyzing SC length and area parameters. Statistical analyses included unpaired t-tests and multivariate regression.

Main Results:

The ripasudil (+) group exhibited significantly longer total SC length (TSC) compared to the ripasudil (-) group.
Significantly larger opened SC area (OSC-A) and TBM-negative opened SC area (NOSC-A) were observed in the ripasudil (+) group.
Multivariate analysis confirmed ripasudil use was independently associated with longer TSC and larger OSC-A and NOSC-A.

Conclusions:

Preoperative topical ripasudil use is associated with the preservation of SC lumen morphology in POAG patients.
Ripasudil appears to maintain SC structure, especially in areas lacking SC endothelium.
These findings support the potential of ROCK inhibitors as a therapeutic strategy to preserve SC morphology and function in glaucoma.