Efficacy and safety of netarsudil for canine corneal endothelial dystrophy

Corneal endothelial dystrophy (CED) is a bilateral, progressive, late-onset disease in dogs characterized by premature loss of endothelial cells, corneal edema, and ocular discomfort due to ulceration. In humans, corneal transplantation is performed to treat the equivalent condition, Fuchs endothelial corneal dystrophy (FECD). Corneal transplants are rarely performed in dogs, therefore, medical treatments urgently needed. Our laboratory demonstrated that the ROCK inhibitor Y27632 accelerated corneal endothelial regeneration in a canine cryoinjury model in vivo, and our preliminary results suggests that the ROCK inhibitor ripasudil delays the progression of CED in some canine patients. Previous work found that netarsudil (Rhopressa®), an FDA-approved medication for human glaucoma, enhanced endothelial recovery in a murine model of FECD. We hypothesize that netarsudil will delay progression of early CED and be well tolerated in dogs.

Participation Requirements:

Dogs presenting or referred to the William R. Pritchard Veterinary Medical Teaching Hospital of the University of California-Davis with clinical suspicion of CED will undergo a complete physical and ophthalmic examination including advanced ocular diagnostic imaging. Only CED affected dogs will be included in this study. Dogs with severe cardiopulmonary disease or neurological conditions will be excluded from the study, as sedation may be required to perform ocular imaging. Dogs with diabetes mellitus, previous or ongoing corneal perforation, anterior uveitis, lens instability, or glaucoma will be excluded as all these conditions could impact endothelial cell density. Our preliminary data that suggests that disease progression can be delayed with ripasudil in early stage. Therefore, CED-affected patient must have at least one eye with less than 40% of the cornea affected with adema.

Owner's Responsibilities:

Owners will be responsible for bringing their dogs for scheduled appointments and fill out surveys before starting the treatment and one, two, four, six and eight months after starting the treatment. They will be ask to administer the drug twice per day to both eyes, and document when medication is given and any missed treatment times. We will ask the owners to withhold food from their dogs the morning of advanced imaging appointments, so that a sedative can be given if necessary.