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Purpose: Rho-associated kinase-inhibitor ripasudil 0.4% eye drops are reportedly effective for the reduction of intraocular pressure (IOP) in glaucoma patients. However, the previous studies investigated the efficacy of IOP reduction for only about 1 year. Here, we evaluated the safety and efficacy of long-term ripasudil instillation in Japanese open-angle glaucoma (OAG) patients. Methods: This study involved 312 eyes of 312 Japanese OAG patients newly initiated with ripasudil treatment at Kyoto Prefectural University of Medicine and Oike-Ikeda Eye Clinic, Kyoto, Japan. In all patients, adverse events leading to discontinuation of ripasudil treatment were investigated. Of the 312 patients, 129 patients able to continue ripasudil administration for over 12-months post-treatment initiation were enrolled to investigate the long-term efficacy. IOP data at 0-, 1-, 3-, 6-, 12-, 18-, and 24-months post initiation of continuous ripasudil use were obtained, and the IOP values at each time point were then compared. The first period (from 1-6 months) and second period (from 12-24 months) IOP data were also compared based on the mixed model. Results: IOP at each time-point post-treatment initiation was significantly reduced compared with that at pre initiation ( P  < 0.05). Differences in IOP between the first and second periods of the study were not statistically significant ( P  = 0.058). Adverse events leading to discontinuation of treatment included blepharitis (15.7%) and conjunctival hyperemia (9.0%). Conclusions: We found that in Japanese OAG patients, 24-month ripasudil eye drop instillation is both safe and effective for lowering IOP and that blepharitis is the primary adverse event for discontinuation of use.

Topical eye-drops remain the cornerstone of treatment for ocular diseases, including glaucoma. Preservatives are added to multi-dose medication bottles to reduce the risk of microbial contamination, to extend the validity of the product and to allow an easily use of the bottles. However the repetitious use of ophthalmic medications containing preservatives, particularly when treating chronic diseases, has been linked to adverse effects and ocular surface disease (OSD). Therefore, this presentation provides an overview of glaucoma and OSD, the role of preservatives in ophthalmic preparations, and the impact of preservatives on the ocular surface.

Background: Contact allergies (CA) against active agents of topical ophthalmological therapeutics, causing inflammation of the conjunctiva and/or the lid, are usually not life-threatening, but occur not infrequently. As yet, the assessment of the CA-eliciting risk has been based on clinical data alone, while a valid epidemiological risk assessment is lacking., Materials and Methods: The Information Network of Departments of Dermatology supplied information on diagnostic results obtained in 4,102 patients patch-tested for suspected CA to ophthalmic drugs between 1995 and 2004. Clinical prevalences were extrapolated to incidences at the German population level. These estimates served as numerator for a relative incidence (RI), which included the nationwide frequency of prescriptions collected by the WIdO, Bonn, in terms of a standardised defined daily dose (DDD) as denominator., Results: The estimated annual incidence of CA ranges from 155 (atropine sulphate) to 2077 (gentamicin sulphate) and can thus be regarded as moderate. If incidence estimates are related to prescription frequencies, the highest risk was found for kanamycin and neomycin sulphate (RI > 8 / 100,000 DDD). In contrast, the RI of pilocarpine-HCl (0.3) was virtually negligible., Conclusions: The substance-specific risk of CA has been evaluated for the first time and found to differ between therapeutics (with a similar spectrum of application). CA risk should be considered in differential therapeutic decision-making.

Allergic reaction to ++anti-cataract eye drops was confirmed in 11.1-34.8 percent of patients with these drops intolerance. Administration of phacolin in capsules to such patients helped eliminate the local allergic reactions. Phacolin had a reparative therapeutic effect in patients with metabolic involvement of the cornea (postherpetic, dystrophic, and other ones). None of the seventy-two patients treated with phacolin, twenty of them were treated with the drug for 2 to 5 years, complained of the drug intolerance.

Medical and pharmacologic research of recent years has led to the development of many potent and efficacious topical ophthalmic medications. Unfortunately, many of these drugs are potentially toxic or allergenic, and their adverse effects have themselves become important external ocular diseases. This paper presents a classification of these adverse effects and provides a review of their etiology, pathogenesis, histopathology, diagnosis, and management. It is hoped that this information will be helpful to ophthalmologists in their efforts to anticipate, prevent, recognize, and treat drug-induced ocular problems and that it will serve to emphasize the importance of avoiding the ill-considered use of medications.

Contact allergy to various components of topical ophthalmological preparations was tested in 27 patients suffering from prolonged or chronic conjunctivitis, keratoconjunctivitis or blepharoconjunctivitis. Our results reveal relevant allergy towards ophthalmological preparations in 44.4% of patients tested. Allergic reactions to topical antibiotics, especially to neomycin (18.5%) and bacitracin (7.4%) was encountered as well as allergy to preservatives such as benzalconium chloride (3.7%). It is essential to bear in mind that contact allergy to components of topical preparations may cause complications and prolongation of symptoms during treatment, and therefore the importance of performing patch tests in prolonged cases of conjunctivitis or keratoconjunctivitis is stressed.