Conservative Management Of Icrs Extrusion: Suture-Assisted Repositioning

Intrastromal corneal ring segment (ICRS) extrusion is a significant complication that often necessitates removal, reversing its therapeutic effects. This case series presents a conservative approach involving suture-assisted repositioning of extruded segments to preserve their benefits while avoiding segment loss or further surgical interventions. The objective is to assess the feasibility, effectiveness, and clinical outcomes of this technique as an alternative to conventional management strategies such as removal followed by allogenic or corneal transplantation.

The study was conducted in Advanced Eye Care Hospital in Beirut, Lebanon, specializing in corneal disorders and refractive surgery. The cases involved two patients with keratoconus who experienced ICRS extrusion and underwent repositioning with sutures as part of a conservative management approach.

Two patients with keratoconus and prior ICRS implantation presented with segment extrusion. Both cases involved significant corneal thinning and a history of eye rubbing, contributing to the complication. Rather than segment removal, a suture-assisted repositioning technique was performed. The extruded segments were carefully realigned within the corneal tunnel and secured with 10-0 nylon sutures. A bandage contact lens was applied postoperatively and replaced every two weeks until the epithelial layer healed gradually. Postoperative management included topical antibiotics and corticosteroids to reduce inflammation and promote corneal stabilization.
Follow-up assessments demonstrated segment stability, improved corneal topography, and maintained visual outcomes without signs of infection or recurrence of extrusion. The intervention preserved the beneficial reshaping effects of the implants while minimizing the need for additional surgical procedures. Finally sutures were removed with significant epithelial healing.

Suture-assisted repositioning of extruded ICRS offers a viable conservative alternative to segment removal, preserving corneal reshaping benefits and avoiding more invasive interventions. The use of bandage contact lenses further supported epithelial healing and postoperative stability. This technique may reduce the need for corneal transplantation in affected patients. Further studies are warranted to validate its long-term efficacy and safety.