{
  "abstract": "A woman in her early 40s was referred to our clinic in the second quarter of 2022 for an evaluation of her corneal condition. She complained about strain and blurry vision in both eyes over a few months, especially during the early hours of the day. After consultation at a local practice, she was advised ripasudil 0.4% eyedrops (Ripatec, Ajanta Pharma, Mumbai, India). Her morning symptoms of blurred vision had largely resolved with the use of medication. At our clinic, her best corrected visual acuity was 20/20 in both eyes. A slit lamp examination revealed fine, numerous, confluent guttae in the central cornea, associated with a well-demarcated geographic patch of fibrillar layer, suggestive of Fuchs’ corneal endothelial dystrophy (FECD) ( figure 1A, B). The rest of the anterior segment and posterior segment was unremarkable. The intraocular pressure measurement around 11.00 was 18 and 19 mm Hg in the right and left eye, respectively. The optic nerve head was normal with a cup disc ratio of 0.3:1 with a healthy neuroretinal rim in both eyes. The anterior segment optical coherence tomography (OCT) (Optovue, USA) showed a regular epithelium, and mild hyperreflectivity of the Descemet membrane in the central cornea in both eyes (figure 1C, D). Specular microscopy (EM-3000, Tomey, Japan) was performed on the patient, focusing on the central and mid-peripheral region of the cornea in both her eyes. The images from the central cornea were non-analysable, as the endothelial cellular morphology could not be obtained due to confluent guttae (figure 1E, G). The endothelial images from the mid-peripheral superior cornea in both eyes showed endothelial cells with areas of dropout, corresponding to guttae (figure 1F, H). Scheimpflug imaging (Pentacam HR, Oculus, Germany) showed loss of parallel isopachs, displacement of the thinnest point of more than 1 mm beyond the pupil centre and posterior surface depression (negative elevation) within 4 mm of cornea in both eyes, suggesting subclinical oedema (figure 2A, B). The patient expressed a preference for medical management alone and was therefore advised to continue ripasudil 0.4% eyedrops two times per day in both eyes. She used the medication regularly, experiencing a favourable outcome, until December 2022. At that point, she discontinued the eye drops as they were no longer available at her location. Subsequently, she visited our clinic with complaints of blurred vision in both eyes. At this visit, her best corrected visual acuity had dropped to 20/40 in the right eye and 20/25 partial in the left eye. The slit lamp examination (figure 3A–D) and the anterior segment OCT (figure 3E, F) revealed bullae and subepithelial oedema in the central cornea overlying the fibrillar layer. The intraocular pressure was 17 and 19 mm Hg in the right and left eye, respectively, at 11.30 am. Scheimpflug imaging showed increased pachymetry and worsening of the parameters noted at the initial visit (figure 2C, D). The same medication, ripasudil 0.4% eye drops, was procured and the patient began to instil the medicine again. On resumption, the blurred vision resolved, and baseline pachymetry was restored in both eyes at the 1 month review visit (Figure 2E, F). Her clinical condition remained stable in the follow-up visits as well. On her most recent visit in December 2024, the patient maintained the best spectacle corrected visual acuity of 20/25, with no visual complaints. The slit lamp examination showed a compact cornea (figure 4A, B). The parameters on anterior segment OCT (figure 4C, D) and Scheimpflug imaging (figure 2G, H) were comparable to the first visit. The intraocular pressure was in the normal range. Table 1 summarises the salient clinical findings at various timelines.",
  "authors": [
    {
      "affiliations": [
        "LV Prasad Eye Institute, Hyderabad, Telangana, India"
      ],
      "name": "SaiLahari Balireddi"
    },
    {
      "affiliations": [
        "Cornea and Anterior Segment, LV Prasad Eye Institute, Hyderabad, Telangana, India"
      ],
      "name": "Sunita Chaurasia"
    }
  ],
  "title": "Management of corneal oedema in Fuchs’ endothelial dystrophy using ripasudil",
  "uid": "0a24fa0a-3294-584b-9fe5-9fe4eb1b8407"
}