ESCRS - PO0144 - Explant Of Extruded Intrastromal Corneal Ring Segment With Intratunnel Riboflavin Injection For Epion Cross-Linking: Functional, Topographic And Biomechanical Improvement After 1-Year

Explant Of Extruded Intrastromal Corneal Ring Segment With Intratunnel Riboflavin Injection For Epion Cross-Linking: Functional, Topographic And Biomechanical Improvement After 1-Year

Published 2023 - 41st Congress of the ESCRS

Reference: PO0144 | Type: Case report | DOI: 10.82333/c25f-b313

Authors: Guilherme Almeida* 1 , Renato Ambrósio Jr. 2

1Ophthalmology,Instituto de Oftalmologia Dr. Gama Pinto,Lisbon,Portugal, 2Instituto de Olhos Dr. Renato Ambrósio/Visare Personal Laser,Rio de Janeiro,Brazil;Ophthalmology,Federal University of the State of Rio de Janeiro (UNIRIO),Rio de Janeiro,Brazil;Rio de Janeiro Corneal Tomography and Biomechanics Study Group,Rio de Janeiro,Brazil

Description of a surgical approach to solve Intrastromal Corneal Ring Segment (ICRS) extrusion, combining its removal with transepithelial Corneal Cross-Linking (TE-CXL).

Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil

Male patient, 36 years old, came to Instituto de Olhos Renato Ambrósio on October 2020, complaining of worsening vision in his right eye (OD) for a year. As per relevant ophthalmological history, he had Keratoconus in both eyes (OU), with previous ICRS implantation with manual technique in OD in 2015. His Uncorrected Distance Visual Acuity (UDVA) was 20/80 on OD and 20/25- on his left eye (OS), giving Best Corrected Distance Visual Acuity (BCVA) of 20/30 and 20/20-2, respectively. Considering the pandemic's clinical impact and symptoms' associated beginning, ectasia progression was presumed as the most probable diagnosis. Consequently, Tel-Aviv protocol was performed on 22nd October 2020, with topography-guided Photorefractive Keratectomy (PRK) done on same day. Patient attained UDVA of 20/20- 1 month after. The patient returns one year after (August 2021), complaining of photophobia and foreign body sensation. Biomicroscopy of OD showed extrusion of the lower extremity of temporal-sided ICRS. The decision to remove the ring was promptly made, associating concurrent TE-CXL treatment (9 mW/cm², 10 min) to prevent infection and further progression of ectasia. UDVA achieved 20/40, 1 month later. Fifteen months later, UDVA improved to 20/30 (CDVA of 25/20) and the topographic profile showed slight flattening of the cornea's shape and biomechanics profile, showing stiffer response during Scheimpflug-based non-contact tonometer assessment.

ICRS implantation is safe and reversible surgery. In cases of extrusion, removal and combination of TE-CXL might improve the biomechanics of the cornea and halt ectasia progression.