Abstract
Keratoconus is a non-inflammatory and degenerative corneal ectasia that determinate progressive steepening of paracentral cornea with development of irregular astigmatism and visual function deterioration. According to the stage of the pathology, different methods of correction can be used: rigid contact lenses may be used to alter corneal shape and partially correct astigmatism, corneal collagen cross-linking (CXL) and intrastromal corneal ring segment (ICRS) implantation can reinforce corneal stroma to slow disease progression. Late-stage treatment comprehend anterior lamellar keratoplasty or penetrating keratoplasty. We evaluated a 31-year-old patient who was subjected to bilateral ICRS implantation combined with CXL due to keratoconus. This led, after 9 months, to ring extrusion in his left eye, corneal thinning and microperforation into the aqueous chamber with residual irregular astigmatism of 4.50 D. cyl. 10°. The patient underwent ICRS explantation and PKP during the same surgical session. After 15 months of follow-up, the BCVA was 0.2 LogMAR with a residual astigmatism of 6.3 dpt.
Highlights
Keratoconus is a non-inflammatory and degenerative corneal ectasia that determinate progressive steepening of paracentral cornea with development of irregular astigmatism and visual function deterioration.According to the stage of the pathology, different methods of treatment can be used: rigid contact lenses may be used to alter corneal shape and partially correct astigmatism, corneal collagen crosslinking (CXL) and intrastromal corneal ring segment (ICRS) implantation can structurally stabilize corneal ectasia
Intrastromal corneal ring segment implantation may be considered in patients affected by mild or moderate keratoconus who do not tolerate rigid contact lenses or in case of inadequate astigmatism correction and visual restoration
As of today, there are no data in the literature related to the use of amniotic membranes in corneal extrusion of ICRS: according to our experience acquired over the years, the insertion of the amniotic membrane is to be considered in these cases only a preliminary and transitory intervention
Summary
Keratoconus is a non-inflammatory and degenerative corneal ectasia that determinate progressive steepening of paracentral cornea with development of irregular astigmatism and visual function deterioration. The two most relevant and frequent postoperative complication of ICRS are functional failure with insufficient correction of ectasia and refractive error, and segment extrusion, with possible damage to corneal epithelium or endothelium [2]. We evaluated a 31-year-old patient who at the age of 30 was subjected to CXL and subsequent (after 8 months) ICRS implantation in his left eye due to keratoconus. As of today, there are no data in the literature related to the use of amniotic membranes in corneal extrusion of ICRS: according to our experience acquired over the years, the insertion of the amniotic membrane is to be considered in these cases only a preliminary and transitory intervention It only allows for temporary tamponade of the situation and does not allow to avoid a subsequent PKP/DALK intervention (depending on the case) and is not able to re-establish the visual function.
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