Cairs Outcomes: Identifying Determinants Of Successful And Unsuccessful Exchange
Published 2025 - 43rd Congress of the ESCRS
Reference: PP14.08 | Type: Free paper | DOI: 10.82333/5wn7-p325
Authors: Despoina Karadimou 1 , Anastasios John Kanellopoulos* 2 , Alexander John Kanellopoulos 1 , Vasiliki Moustou 1 , Niki Tsirimpasi 1
1Ophthalmology,Laservision ASU,Athens,Greece, 2Ophthalmology,Laservision ASU,Athens,Greece;Ophthalmology,NYU Med School,New York,United States
Purpose
To assess risk factors for CAIRS (corneal allogeneic intrastromal ring segment) failure and identify patients who may benefit from secondary exchange, as well as when CAIRS is less suitable as a primary treatment for keratoconus.
Setting
Rothschild Foundation Hospital, Paris
Methods
This study included all patients who underwent CAIRS surgery at the Rothschild Foundation between September 2022 and February 2025. We identified dissatisfied patients and assessed preoperative parameters, including keratoconus pattern, ABCD classification, best-corrected visual acuity (BCVA), refraction, and keratometric and aberrometric data using the Pentacam system (Oculus, Wetzlar, Germany). Postoperative follow-up included ophthalmological, topographical, and aberrometric evaluations at 3 and 6 months. Patients who underwent one or two exchanges were monitored after each procedure, with surgical planning adapted based on keratoconus type, preoperative topography, and postoperative outcomes.
Results
Among 102 CAIRS-operated patients since 2022, 16.7% (17 eyes) were dissatisfied. Of these, 10 underwent one exchange, 2 had two exchanges, and 1 had CAIRS removed. Dissatisfied patients had a higher prevalence of central (nipple) and non-axial (duck/skewed duck) keratoconus but similar preoperative visual, keratometric, and aberrometric parameters (p > 0.05).
Post-exchange, 6/13 patients were satisfied. Successful exchanges were associated with better BCVA (0.24 ± 0.14 logMAR vs. 0.52 ± 0.36 logMAR), lower mean/maximal keratometry (47.2 ± 2.63 D / 54.7 ± 2.1 D vs. 53.3 ± 9.3 D / 64.8 ± 10.1 D), and fewer aberrations (RMS 12.26 ± 3.2 vs. 16.89 ± 10.33, vertical coma 1.72 ± 0.61 vs. 2.86 ± 1.54).
Conclusions
CAIRS can be performed for all keratoconus types; however, patient expectations should be carefully managed, particularly in cases of central, advanced keratoconus with low preoperative visual acuity.