The use of Rho Kinase (ROCK) inhibitors as therapeutic agents in ophthalmology has been a topic of discussion for several years, particularly in the realm of glaucoma, Fuchs endothelial dystrophy, and diabetic retinopathy. the potential to be another potent therapeutic option for several chronic diseases in ophthalmology. strong class=”kwd-title” Key Words: Rho Kinase Inhibitors, ROCK, Glaucoma, Intraocular Pressure, Corneal Endothelium, Diabetic Retinopathy INTRODUCTION Function of Rho kinase Rho kinase is a serine/threonine protein kinase involved in the regulation and modulation of cell shape and size via action on the cytoskeleton . As downstream effectors of Rho GTPase, Rho kinases are involved in calcium-independent regulation of smooth muscle contraction . Furthermore, they have been linked with the control of cytoskeletal dynamics, actomyosin contractile forces, cell adhesion, cell stiffening, extracellular matrix reorganization, and cell morphology . These factors have been BSF 208075 cell signaling shown to be determinants of Aqueous Humor (AH) outflow via the trabecular pathway, which consists of Schlemms canal, trabecular meshwork, and juxtacanalicular tissue [4, 5]. Therefore, through physiological evidence, a direct relationship is suggested between Rho kinase functionality and AH outflow passing through the trabecular pathway. History of Rho kinase Inhibitors BSF 208075 cell signaling As knowledge has been obtained regarding Rho kinases, the relationship between this enzyme and certain physiological problems has come to light. Research on Rho kinase began in the late 1990s and has continued to the present time [1, 4, 6, 7]. The majority of research has emphasized on Intraocular Pressure (IOP) lowering the effect of Rho Kinase (ROCK) inhibitors. Fewer studies have dealt with the restorative effect a Rho kinase inhibitor has on diabetic retinopathy and the healing effects on the corneal BSF 208075 cell signaling endothelium. At present, further research is being conducted on different treatment options, dosages, and formulas for Rho kinase inhibitors in ophthalmology. In 1998, Alan Hall elucidated the relationship between the Rho pathway and actin cytoskeleton functions. He showed that the Rho kinase pathway was an important regulator of the actin cytoskeleton and that various reactions within the pathway, coordinated with many cellular responses and changed different characteristics, such as shape and adhesion.1 In 2001, studies began at both the University of Tokyo in Japan and Duke University in North Carolina to investigate the effects of Rho kinase inhibitors on lowering of IOP [8, 9]. They were designed to discover how AH outflow facility was increased by the ROCK inhibitors. The studies showed that, by inhibiting the Rho pathway, cells in the trabecular meshwork would alter in ways that allowed for increased outflow of AH. In the late 2000s, studies commenced to determine if ROCK inhibitors could be used as treatment for glaucoma. Many of these studies were pioneered by the same people, who had investigated the IOP-lowering effects of Rho kinase inhibitors, namely Rao, Epstein, Vasantha, Honjo, and Tanihara, along with other collaborators [2, 9, 10]. After this period of discovery, others began research on the use of Rho kinase Fam162a inhibitors as treatments for other ophthalmologic diseases. From 2010 to the present time, studies have been done to investigate the further use of Rho kinase inhibitors for different conditions, such as diabetic retinopathy and corneal endothelial damage . As knowledge was gained from these investigations, further clinical trials have been performed to determine the correct formula, dosage, and duration of use of Rho kinase inhibitors [11-15]. In 2014, ripasudil, a ROCK inhibitor, gained approval in Japan to be used for treatment of ocular hypertension and glaucoma [5 particularly, 16-18]. Lately as Dec 18th As, 2017, Rhopressa, a Rho kinase inhibiting medication comprising Netarsudil, gained Meals and Medication Administration (FDA) authorization; the to begin its kind to take action in america of America . Rho kinase Signaling Pathway Rho kinase can be a downstream effector from the RhoA proteins, a little GTPase. GTPases alternative between two conformations: a Guanosine Triphosphate (GTP)-destined energetic conformation and a Guanosine Diphosphate (GDP)-destined inactive conformation. This GTPase activation rules is managed by Guanine nucleotide Exchange Elements (GEFs), GTPase Activating Protein (Spaces), and Guanine nucleotide.