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Volume 14
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10.3390/jcm14176093
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

RhoKinase (ROCK) Inhibition as a Therapeutic Strategy for Pseudophakic Bullous Keratopathy: A Comprehensive Review

by
Anđela Jukić
1,*,
Josip Pavan
1,
Biljana Đapic Ivančić
2,
Miro Kalauz
3,4,
Rajka Kasalica Žužul
1 and
Tomislav Jukić
3,4
1
Department of Ophthalmology, University Hospital Dubrava, 10000 Zagreb, Croatia
2
Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
3
Department of Ophthalmology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
4
School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 6093; https://doi.org/10.3390/jcm14176093
Submission received: 27 July 2025 / Revised: 22 August 2025 / Accepted: 28 August 2025 / Published: 28 August 2025
(This article belongs to the Section Ophthalmology)
Versions Notes

Abstract

Pseudophakic bullous keratopathy (PBK) is a vision-threatening corneal complication following cataract surgery, characterised by progressive endothelial cell loss, persistent corneal oedema, and painful epithelial bullae, leading to impaired vision. Corneal transplantation, either penetrating or endothelial keratoplasty, remains the primary treatment but faces challenges such as donor tissue shortages, graft rejection, and limited graft longevity. Recently, Rho-kinase (ROCK) inhibitors have emerged as promising pharmacological alternatives. These agents enhance corneal endothelial cell proliferation, migration, and adhesion, suppress apoptosis, and promote corneal deturgescence and wound healing. Several preclinical and clinical studies have demonstrated the efficacy of ROCK inhibitors in improving corneal clarity, endothelial function, and visual acuity in PBK. Their use has been associated with reductions in corneal oedema, improved endothelial cell density, and delayed or prevented the need for corneal transplantation. A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted, restricted to peer-reviewed English-language articles, ensuring comprehensive coverage. ROCK inhibitors represent a novel pharmacological strategy for PBK prevention and management, potentially reducing dependency on donor grafts. Further research is needed to determine long-term safety, optimal dosing, and efficacy.
Keywords: pseudophakic bullous keratopathy; Rho-kinase inhibitors; corneal endothelium; corneal oedema; ripasudil; netarsudil pseudophakic bullous keratopathy; Rho-kinase inhibitors; corneal endothelium; corneal oedema; ripasudil; netarsudil

Share and Cite

MDPI and ACS Style

Jukić, A.; Pavan, J.; Đapic Ivančić, B.; Kalauz, M.; Kasalica Žužul, R.; Jukić, T. RhoKinase (ROCK) Inhibition as a Therapeutic Strategy for Pseudophakic Bullous Keratopathy: A Comprehensive Review. J. Clin. Med. 2025, 14, 6093. https://doi.org/10.3390/jcm14176093

AMA Style

Jukić A, Pavan J, Đapic Ivančić B, Kalauz M, Kasalica Žužul R, Jukić T. RhoKinase (ROCK) Inhibition as a Therapeutic Strategy for Pseudophakic Bullous Keratopathy: A Comprehensive Review. Journal of Clinical Medicine. 2025; 14(17):6093. https://doi.org/10.3390/jcm14176093

Chicago/Turabian Style

Jukić, Anđela, Josip Pavan, Biljana Đapic Ivančić, Miro Kalauz, Rajka Kasalica Žužul, and Tomislav Jukić. 2025. "RhoKinase (ROCK) Inhibition as a Therapeutic Strategy for Pseudophakic Bullous Keratopathy: A Comprehensive Review" Journal of Clinical Medicine 14, no. 17: 6093. https://doi.org/10.3390/jcm14176093

APA Style

Jukić, A., Pavan, J., Đapic Ivančić, B., Kalauz, M., Kasalica Žužul, R., & Jukić, T. (2025). RhoKinase (ROCK) Inhibition as a Therapeutic Strategy for Pseudophakic Bullous Keratopathy: A Comprehensive Review. Journal of Clinical Medicine, 14(17), 6093. https://doi.org/10.3390/jcm14176093

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