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• ROCK THE MEDIA ! Adding ROCK inhibitors to donor corneal storage media to improve corneal endothelial cell function
  Radhika Natarajan
  Published on: 22 March 2021

• Published on: 22 March 2021

  ROCK THE MEDIA ! Adding ROCK inhibitors to donor corneal storage media to improve corneal endothelial cell function

  • Radhika Natarajan, Cornea surgeon Sankara Nethralaya, Medical Research Foundation, Chennai, India

  We read with interest this article by Ong HS et al on “Evolution of therapies for the corneal endothelium: past, present and future approaches”.

  As the article mentions, Rho kinase (ROCK) inhibitors have been described in the regenerative approach to corneal endothelial injury by aiding cell proliferation.1 Due to the wide range of cellular responses controlled by the Rho kinase signalling pathway, ROCK inhibitors play a part in increasing cell adhesion and proliferation of the corneal endothelium. Their clinical use has also been reported with success in Fuch’s endothelial dystrophy and pseudophakic corneal decompensation. 0.4% Ripasudil eye drop is the common agent used in these studies.2
  Enriching nutrients, antibiotics and other additives have been described in literature to add value to corneal preservation media. It would be interesting to see if addition a Rho kinase inhibitor to the donor corneal preservation medium could enhance the endothelial cell count or limit attrition over longer preservation times. The parameters of the drop in terms of strength, solubility, minimum concentration, side effects if any etc. need to be evaluated prior. Of all the methods described to improve the corneal endothelial health, this is the only one that may be extrapolated to donor corneal tissue also, for better surgical outcomes
  It may be worthwhile to test if adding a ROCK inhibitor may enhance donor corneal tissue viability in storage media, under controlled...

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  We read with interest this article by Ong HS et al on “Evolution of therapies for the corneal endothelium: past, present and future approaches”.

  As the article mentions, Rho kinase (ROCK) inhibitors have been described in the regenerative approach to corneal endothelial injury by aiding cell proliferation.1 Due to the wide range of cellular responses controlled by the Rho kinase signalling pathway, ROCK inhibitors play a part in increasing cell adhesion and proliferation of the corneal endothelium. Their clinical use has also been reported with success in Fuch’s endothelial dystrophy and pseudophakic corneal decompensation. 0.4% Ripasudil eye drop is the common agent used in these studies.2
  Enriching nutrients, antibiotics and other additives have been described in literature to add value to corneal preservation media. It would be interesting to see if addition a Rho kinase inhibitor to the donor corneal preservation medium could enhance the endothelial cell count or limit attrition over longer preservation times. The parameters of the drop in terms of strength, solubility, minimum concentration, side effects if any etc. need to be evaluated prior. Of all the methods described to improve the corneal endothelial health, this is the only one that may be extrapolated to donor corneal tissue also, for better surgical outcomes
  It may be worthwhile to test if adding a ROCK inhibitor may enhance donor corneal tissue viability in storage media, under controlled conditions.

  REFERENCES:

  1. Okumura N, Okazaki Y,Inoue R, Kazuya Kakutani, et al. Effect of the Rho-Associated Kinase Inhibitor Eye Drop (Ripasudil) on Corneal Endothelial Wound Healing. Invest. Ophthalmol. Vis. Sci. 2016;57(3):1284-1292.

  2. Moshirfar M, Parker L, Birdsong OC, et al. Use of Rho kinase Inhibitors in Ophthalmology: A Review of the Literature. Med Hypothesis Discov Innov Ophthalmol. 2018;7(3):101-111.

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  Conflict of Interest:
  None declared.

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