Rho-kinase inhibitors reduce intraocular pressure by 9.32 mmHg at 3 months in uveitic glaucoma patients

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Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Aguilar-Barrera Blanca, Mejía-Salgado Germán, Cardona-López Juanita, Reyes-Troncoso Alejandra, Acost… PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Rho-kinase inhibitors lower IOP significantly in uveitic glaucoma with a favorable safety profile.

This systematic review and meta-analysis assessed the efficacy and safety of Rho-kinase inhibitors in patients with uveitic glaucoma or ocular hypertension secondary to uveitis. The analysis included 383 participants and 256 eyes across studies with follow-up of 3 months and 12 months. No specific comparator was reported in the synthesis. The primary outcome was intraocular pressure reduction.

The results demonstrated a statistically significant reduction in intraocular pressure at 3 months with a mean difference of -9.32 mmHg (95% CI: -17.02 to -1.62). At 12 months, the effect was sustained with a mean difference of -7.92 mmHg (95% CI: -10.28 to -5.56). The authors describe this as a favorable safety profile with no major differences found between ripasudil and netarsudil regarding adverse events.

Adverse events included conjunctival hyperemia with a pooled prevalence of 6% (95% CI: 3%-15%), ocular pain, and blurred vision. Serious adverse events and discontinuations were not reported. The authors highlight that some studies reported outcomes per eye while others reported outcomes only per patient. Additionally, two studies had a low risk of bias, four raised some concerns, and five were at high risk of bias.

The authors conclude that ROCK inhibitors demonstrate significant and sustained IOP-lowering effects. Their additive effect with conventional treatments and potential benefits in surgical outcomes highlight their role as promising therapeutic agents. However, further clinical trials are needed to compare different ROCK inhibitors and assess their long-term safety and effectiveness in different populations.

Study Details

Study typeMeta analysis

Sample sizen = 10

EvidenceLevel 1

PublishedJun 2026

PMID41632210

View Original Abstract ↓

PURPOSE: To evaluate the efficacy, effectiveness, and safety of Rho-kinase (ROCK) inhibitors in the management of uveitic glaucoma (UG) and ocular hypertension secondary to uveitis (OHT-SU) through a systematic review and meta-analysis. METHODS: We systematically searched PubMed, EMBASE, Virtual Health Library, and medRxiv databases until October 29, 2024, for studies evaluating UG or OHT-SU patients treated with ROCK inhibitors. Eligible designs included case series with over 10 patients, cross-sectional studies, cohort studies, and randomized controlled trials. Risk of bias was assessed using the CLARITY tools and validated metrics such as those developed by Hoy et al., Hassan Murad et al., and the RoB-2 tool. A pressure (IOP) reduction meta-analysis at different follow-up points was conducted using R software. The study was registered in PROSPERO with the CRD42024618812 number. RESULTS: Eleven studies (383 participants, 256 eyes) were analyzed. Some studies reported outcomes per eye, whereas others reported outcomes only per patient; thus, the number of eyes reflects only explicitly reported data. Based on the risk of bias assessment, two studies had a low risk of bias, four raised some concerns, and five were at high risk of bias. Pooled mean age was 64.2 ± 15.2 years (from 10 studies reporting age); sex distribution (50.5% male, 49.5% female, from 7 studies reporting gender). ROCK inhibitors achieved a statistically significant reduction in IOP at 3 months (mean difference: -9.32 mmHg, 95% CI: -17.02 to -1.62). These effects were sustained at 12 months (-7.92 mmHg, 95% CI: -10.28 to -5.56). Combination therapy enhanced pressure control. The most common adverse event was conjunctival hyperemia, with a pooled prevalence of 6% (95% CI: 3%-15%), followed by ocular pain and blurred vision. Importantly, no major safety differences were found between ripasudil and netarsudil. Additionally, ROCK inhibitors also improved surgical outcomes in UG patients. CONCLUSION: ROCK inhibitors demonstrate significant and sustained IOP-lowering effects in UG and OHT-SU with a favorable safety profile. Their additive effect with conventional treatments and potential benefits in surgical outcomes highlight their role as promising therapeutic agents. Further clinical trials are needed to compare different ROCK inhibitors and assess their long-term safety and effectiveness in different populations.