Responsiveness to ripasudil predicts selective laser trabeculoplasty success in POAG

The responsiveness to ripasudil treatment may be a good indicator of the therapeutic effect of selective laser trabeculoplasty (SLT) among patients with primary open-angle glaucoma (POAG), a recent study has found.

The researchers enrolled 70 eyes from 70 patients who had no history of glaucoma surgery. Participants were divided into two according to responsiveness to ripasudil, as defined by an intraocular pressure (IOP) drop <15 percent: effective (n=22; mean age, 72.1±11.6 years; 15 men) and noneffective (n=48; mean age, 70.1±8.3 years; 25 men). All patients underwent SLT.

The main outcome of interests included treatment success and survival and change in IOP.

IOP dropped in both groups following SLT. Mean IOP in the effective group went from 19.9±5.9 mm Hg at baseline to 18.1±7.5 mm Hg at the 6-month follow-up. Values continued to decline, reaching a minimum of 15.9±6.5 mm Hg at 18 months before rebounding slightly to 17.4±6.0 mm Hg at 24 months.

In the noneffective group, IOP dropped from 21.1±7.1 mm Hg at baseline to 16.9±5.7 mm Hg at month 6, where it remained relatively stable. At 24 months, mean IOP in this group was 16.8±3.7 mm Hg.

Kaplan-Meier survival curves showed that surgical success rates were significantly better at all time points in patients responsive to ripasudil. At 24 months, for instance, success rate was 24.9 percent in the effective group, as opposed to only 9.3 percent in the noneffective group.

Cox proportional hazards regression analysis confirmed that the effectiveness of ripasudil was a significant correlate of SLT success, such that patients who were responsive saw their risk of failure nearly halved (risk ratio, 0.53, 95 percent confidence interval, 0.285–0.965; p=0.04).

“In the ripasudil effective eyes, there was a significantly higher cumulative probability of SLT success after the procedure as compared to that observed in the noneffective eyes. To the best of our knowledge, this is the first report to provide details on the relationship between ripasudil effective eyes and SLT success,” the researchers said.