{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:03Z","timestamp":1756339503387,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,11,9]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>We present a case of a male patient in his mid-50s who presented with bullous keratopathy secondary to an anterior chamber intraocular lens, complicated by superimposed honeycomb keratopathy while on ripasudil 0.4%. The bullous keratopathy was characterised by generalised microcystic epithelial oedema, alongside more centrally located, variable-sized macrocystic epithelial oedema with a honeycomb appearance. Discontinuation of ripasudil resulted in the resolution of the honeycomb keratopathy, although with the persistence of pre-existing microcystic corneal oedema. This case highlights the complexity of ripasudil\u2019s effects on corneal endothelium, showing a paradoxical response. Timely identification of ripasudil-induced keratopathy is crucial, particularly in cases when it is started elsewhere, emphasising the necessity for vigilant monitoring and management strategies.<\/jats:p>","DOI":"10.1136\/bcr-2024-261052","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T20:35:21Z","timestamp":1733344521000},"page":"e261052","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ripasudil\u2019s paradox: bullous keratopathy with honeycomb twist"],"prefix":"10.1136","volume":"17","author":[{"given":"Nidhi","family":"Mamtani","sequence":"first","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences, Nagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-820X","authenticated-orcid":false,"given":"Sagarika","family":"Snehi","sequence":"additional","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences, Nagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5698-3029","authenticated-orcid":false,"given":"Kanishk","family":"Singh","sequence":"additional","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences, Nagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Pattebahadur","sequence":"additional","affiliation":[{"name":"Ophthalmology, All India Institute of Medical Sciences, Nagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"2025082708320614000_17.12.e261052.1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1590\/S0004-27492008000700012","article-title":"Bullous keratopathy: etiopathogenesis and treatment","volume":"71","author":"Gon\u00e7alves","year":"2008","journal-title":"Arq Bras Oftalmol"},{"key":"2025082708320614000_17.12.e261052.2","doi-asserted-by":"crossref","first-page":"90","DOI":"10.22336\/rjo.2017.17","article-title":"Pseudophakic bullous keratopathy","volume":"61","author":"Pricopie","year":"2017","journal-title":"Rom J Ophthalmol"},{"key":"2025082708320614000_17.12.e261052.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1350-9462(02)00065-4"},{"key":"2025082708320614000_17.12.e261052.4","unstructured":"Role of the rho GTPase\/Rho kinase signaling pathway in pathogenesis and treatment of glaucoma: bench to bedside research-PubMed. n.d. 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