Intracorneal Ring Segment Penetration Into The Cornea And Iris: A Case Report

Intracorneal ring segments (ICRS) are often used in the treatment of keratoconus and other ectatic disorders to flatten the cornea and improve visual acuity. Despite their efficacy, complications can occur, including infection, segment extrusion, and, rarely, migration of the segment into deeper ocular structures. We report a case of an ICRS penetrating the cornea and iris, a rare and challenging complication that requires prompt intervention.

A 20-year-old man with history of keratoconus presented to the clinic with complaints of decreased vision, Fb sensation and photophobia after ICRS implantation elsewhere. Visual acuity was CF 3m. The diagnosis was made of ICRS migration with cornel and iris perforation, and immediate surgical intervention was planned to remove the ICRS together with AC wash.

Clinical Findings

• Examination: On slit-lamp examination, corneal sutures for a full thickness corneal defect with a very wide iris punched out defect.
• Visual Acuity: Cf 3 meters.
• Anterior Segment OCT: revealed absence of the ICRS and increased corneal thickness at the surrounding site.

Surgical Management:

• Absence of the ICRS with the presence of punched out defect raised the suspicion of migration of the ICRS to the posterior chamber. The patient was kept in a dark room and face down position for almost 30 minutes. The ring was then found floating in the AC. Patient was prescribed miotics and scheduled for ring extraction in the next day. Attempts with removal of the ICRS using McPherson forceps, micro-forceps, and a Sinskey hook was very difficult and failed multiple times. The procedure was challenging and required careful manipulation. Ultimately, the ICRS was successfully removed, and anterior chamber washout was performed to prevent further complications such as corneal decompensation or endophthalmitis

Outcome and Follow-Up

• Postoperative Care: Postoperative management included topical antibiotics, steroids.
• Visual Outcome: At 1 week follow-up, the patient had a visual acuity of 0.05. The corneal integrity was healing, and no further complications were noted aside from residual astigmatism.

ICRS implantation can lead to rare but serious complications, such as corneal and iris penetration. Timely surgical intervention is necessary to prevent long-term damage and preserve vision.