Ripasudil for Enhanced Corneal Clearing Following Descemet Membrane Endothelial Keratoplasty in Fuchs' Dystrophy

Inclusion Criteria: * Diagnosed clinically with Fuchs endothelial corneal dystrophy by the study investigator. * Phakic or pseudophakic with posterior capsule supported, suture-fixated, or sulcus-supported posterior chamber intraocular lens. * Fuchs dystrophy grades 2-5 on the Krachmer grading scale. * Presence of central guttae and/or stromal edema being the primary cause of decreased vision. * The peripheral cornea to the central 6mm is devoid of guttata changes. * Best corrected visual acuity in the study eye is 20/40 or worse with glare testing at study enrollment. Exclusion Criteria: * Uncontrolled glaucoma (IOP \>25 mmHg). * Presence of secondary corneal pathology such as infective or autoimmune keratitis. * Advanced corneal stromal edema with bullae on slit-lamp biomicroscopy. * History of herpes simplex virus or cytomegalovirus keratitis. * Prior penetrating keratoplasty. * Aphakic in study eye. * Allergy to any component of the Ripasudil hydrochloride hydrate 0.4% that will be used in the course of the study. * Tubes or trabeculectomy from prior glaucoma surgery.