Utilization Of Dehydrated Amniotic Membrane For The Treatment Of Corneal Melting Post Corneal Allogenic Intrastromal Ring Segment Implantation, A Case Study

The purpose of this paper is to present a case report detailing the management of corneal melt following Corneal Allogenic Intrastromal Ring Segment (CAIRS) implantation for the treatment of keratoconus. This case report highlights the successful use of dehydrated amniotic membrane transplantation (AMT) and a bandage contact lens (BCL) in addressing corneal melt post-CAIRS implantation in a 19-year-old male patient. The paper aims to shed light on the effective management strategies for corneal melt complications associated with CAIRS and emphasizes the importance of further research to explore potential complications and optimal management approaches related to CAIRS in clinical practice.

Corneal allogenic intrastromal ring segments takes advantage of the immunological compatibility of allograft tissue to facilitating smoother integration with the host cornea which greatly minimizes the chances of complications .Corneal melt is an uncommon but dangerous consequence in which the corneal stroma thins and the corneal epithelium is destroyed. It can result in corneal perforation and loss of vision. This is, to our knowledge, the first reported case of Melting post CAIRS

 A 19-year-old male keratoconus patient who had CAIRS implantation then two week later the patient experienced a sensation of having a foreign object in the eye after vigorous rubbing due to dusts exposure, examination revealed mild conjunctival injection with minimal white discharge. The corneal ring was in place, except for the middle part of the segment which was bulging (Extrusion) with melted cornea avove. from previous CAIRS experience we knew that allogenic segments takes almost 3 months to integrate within corneal lamella so We decided not to remove it but to start by applying multilayers dehydrated amniotic membrane transplantation (AMT), (AMBIO2) from (KATENA) along with a bandage contact lens (BCL) to aid healing. The patient was kept on topical (prednisolone acetate 1%) every 6 hours, and topical moxifloxacin four times a day (QID). The patient was scheduled for follow-up in one week for further assessment and advised to avoid rubbing and seek ophthalmic ER if any worsening in vision or symptoms.After two weeks upon follow up the segment was completely covered by epithelium and negative stains with fluorescence seen upon removal of BCL (figure 3) , the patient advised to avoid rubbing and keep lubricating his eye every two hours along with tapering topical PredForte.

We kept following the patient with Anterior Segment OCT (Heidelberg) in all visits to measure the depth of the segments which revealed deepening of the segment and build of stromal tissue above it.

  This case report highlights that melting post CAIRS can be managed with applying dehydrating AMTs with BCL as an office based procedure till the segment start to intersect within the corneal lamellae and we still need further studies to identify possible complications of CAIRS, the risk factors for such complication and to design measures to avoid it and manage it in clinical practice.