title: Intravitreal fasudil combined with bevacizumab for treatment of refractory diabetic macular edema; a pilot study.
abstract: OBJECTIVE
  To evaluate the effect of intravitreal injection of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) combined with intravitreal bevacizumab (IVB) on refractory diabetic macular edema (DME).
  
  
  METHODS
  This prospective, interventional case series included 15 eyes of 15 patients with DME unresponsive to previous IVB injections. Eligible eyes underwent intravitreal injection of 0.025 mg Fasudil and 1.25 mg bevacizumab. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before and 4 weeks after treatment.
  
  
  RESULTS
  Mean age was 64.6±7.3 (range, 49-79) years and mean number of previous IVB injections was 2.8. Mean pre-injection BCVA was 0.84±0.35 LogMAR, which was improved to 0.49±0.29 LogMAR four weeks after intervention (P=0.003). Mean CMT was decreased from 448±123 µm before treatment, to 347±76 µm at four weeks (P=0.001); no adverse event was observed during the study period.
  
  
  CONCLUSIONS
  Intravitreal ROCK inhibitors seem to entail structural and visual benefits in eyes with DME refractory to IVB monotherapy.
authors.affiliation: Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Nourinia
authors.affiliation: Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ahmadieh
authors.affiliation: Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad-Hassan
authors.initials: MH
authors.lastname: Shahheidari
authors.affiliation: Center for Excellence in Functional and Molecular Imaging, Brigham and Women's Hospital, and Department of Radiology, Harvard Medical School, Boston, MA, USA.
authors.forename: Souska
authors.initials: S
authors.lastname: Zandi
authors.affiliation: Center for Excellence in Functional and Molecular Imaging, Brigham and Women's Hospital, and Department of Radiology, Harvard Medical School, Boston, MA, USA.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Center for Excellence in Functional and Molecular Imaging, Brigham and Women's Hospital, and Department of Radiology, Harvard Medical School, Boston, MA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Hafezi-Moghadam
keywords: Angiogenesis; Diabetic Macular Edema; Rho Kinase