Elsevier

Ophthalmology

Volume 111, Issue 4, April 2004, Pages 747-751
Ophthalmology

Original article
Changes in keratoconic corneas after intracorneal ring segment explantation and reimplantation

https://doi.org/10.1016/j.ophtha.2003.08.024Get rights and content

Abstract

Purpose

To evaluate the outcome and potential reversibility of the changes induced in keratoconic eyes after intracorneal ring segment explantation.

Design

Retrospective, interventional case series.

Participants

Five eyes of 4 patients who underwent uneventful implantation of one or two intracorneal ring segment segments for the correction of clear corneal keratoconus and who required explantation of one segment due to complications.

Main outcome measures

Visual acuity, refraction, keratometric readings, and corneal topography. The follow-up was up to 1 year from the primary implantation procedure in all cases.

Results

Explantation was performed easily in all cases without intraoperative or postoperative complications. The segments were extracted due to migration and local melting. The visual, refractive, and topographic map findings regressed to approximate the original clinical situation before segment implantation.

Conclusions

Intracorneal ring segments are safely and easily explanted from keratoconic eyes. Most of the visual, refractive, and topographic findings return to near the preimplantation levels.

Section snippets

Patients and methods

We conducted a retrospective chart analysis in which we evaluated the visual, refractive, and topographic changes observed in 5 eyes of 4 patients who had uneventful intracorneal ring segment implantation for clear corneal keratoconus, in which extraction of the segments was necessary during the follow-up period. Three eyes were primarily implanted with 2 segments (0.25 mm superiorly and 0.45 mm inferiorly), and the other 2 with only 1 inferior segment (0.45 mm). In 4 of the 5 eyes the segments

Case 1: extrusion with melting of intracorneal ring segments and explantation

A 32-year-old female had bilateral clear central keratoconus further advanced in her right eye. Corneal topography showed the presence of corneal steepening (Fig 1A).

In February 2000, the patient had uneventful implantation of 2 intracorneal ring segments in her right eye: an inferior 0.45-mm-thick segment and a superior segment of 0.25 mm.

Marked improvement was reported by the patient during the first postoperative months, as evidenced by the UCVA (20/100), best-corrected visual acuity (BCVA)

Discussion

Intracorneal ring segment implantation is a relatively new technique, originally designed to correct low degrees of myopic errors. As intracorneal ring segment placement does not involve the direct manipulation of the central cornea or tissue removal, the outcome of the procedure does not depend on individual wound healing characteristics. In addition, the normal prolate surface asphericity of the cornea is preserved.8, 9, 10

The reversibility and adjustability of the refractive effect of

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Manuscript no. 220971.

The authors have no proprietary interest in the development or marketing of any products or medical equipment used in this study.

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