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

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 0.025 mg/0.05 mL 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 treat-ment, 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 mod-erate visual benefits in eyes with DME refractory to IVB. Such effects may be functionally significant without obvious anatomical improvement.(c) 2023 Elsevier Masson SAS. All rights reserved.