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Purpose: To investigate whether the topical administration of ripasudil ophthalmic solution enhances aqueous outflow in the episcleral vein of the human eye.Design: Two-sequence, prospective, randomized, double-blind, crossover trial.Participants: Sixteen eyes of 16 healthy participants were recruited in this study.Methods: Participants were randomized into one of the two crossover sequences to the instillation of ripasudil or the control drug, latanoprost, followed by a washout period of more than 2 days, and crossed over to the alternative instillation. The aqueous columns in the episcleral veins were recorded using a video capture system connected to a slit-light microscope (hemoglobin video imaging) before and 2 and 8 h after the instillation.Primary Outcome Measure: Comparisons between ripasudil and latanoprost for the changes of the aqueous column width after the instillation.Results: Two hours after the instillation, the ripasudil group had significantly greater dilation of the aqueous column width than the latanoprost group. Eight hours after the instillation, the ripasudil group had significantly greater dilation of the aqueous column width than the latanoprost group.Conclusions: Hemoglobin video imaging revealed the dilation of the aqueous column width in the episcleral veins of the human eye after the instillation of ripasudil ophthalmic solution.

A 5-year-old girl with metatropic dysplasia was scheduled for an operation of posterior cervical fusion. This disease is a rare skeletal dysplasia characterized by long trunk and short limbs and severe scoliosis. As she had been suspected to have a difficult airway, we attempted fiberoptic intubation with a nasopharyngeal airway to prevent airway obstruction. The nasopharyngeal airway ensured a patent airway sufficient oxygenation, and anesthesia. Thus, it was possible to perform a fiberoptic intubation via the opposite nostril with no adverse event. The combination of a nasopharyngeal airway and fiberoptic guided tracheal intubation is a reliable and safe procedure for small children with metatropic dysplasia and difficult airway.