Rho-Kinase Inhibitors for the Treatment of Refractory Diabetic Macular Oedema

Diabetic macular oedema (DMO) is one of the leading causes of vision loss associated with diabetic retinopathy (DR). New insights in managing this condition have changed the paradigm in its treatment, with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) having become the standard therapy for DMO worldwide. However, there is no single standard therapy for all patients DMO refractory to anti-VEGF treatment; thus, further investigation is still needed. The key obstacles in developing suitable therapeutics for refractory DMO lie in its complex pathophysiology; therefore, there is an opportunity for further improvements in the progress and applications of new drugs. Previous studies have indicated that Rho-associated kinase (Rho-kinase/ROCK) is an essential molecule in the pathogenesis of DMO. This is why the Rho/ROCK signalling pathway has been proposed as a possible target for new treatments. The present review focuses on the recent progress on the possible role of ROCK and its therapeutic potential in DMO. A systematic literature search was performed, covering the years 1991 to 2021, using the following keywords: rho-Associated Kinas-es, Diabetic Retinopathy, Macular Edema, Ripasudil, Fasudil and Netarsudil. Better insight into the pathological role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.

Automated summary

Diabetic macular oedema (DMO) is a leading cause of vision loss associated with diabetic retinopathy (DR), and anti-VEGF therapy has become the standard treatment worldwide. However, there is no single standard therapy for all patients with DMO refractory to anti-VEGF treatment. The Rho/ROCK signaling pathway has been identified as a potential target for new treatments, and a better understanding of the role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.