Managing The Unexpected: Extrusion Of An Allogenic Intrastromal Ring Segment (Cairs) Implant In A Keratoconus Patient
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR030 | Type: Case Report | DOI: 10.82333/b6ta-3716
Authors: Dr Rodrigo Ernesto Barrera Rodriguez* 1 , Dr Soosan Jacob 2
1Cornea,Fundacion Oftalmologica Nacional,Bogota,Colombia;Ocular Ultrasound,Clinica Barraquer,Bogota,Colombia;Cornea,Asociacion para evitar la ceguera,Ciudad de mexico,Mexico, 2Cornea,Dr Agarwals Eye Hospital ,Chennai,India
Purpose
To report a case of extrusion of a Corneal Allogenic Intrastromal Ring Segment (CAIRS) in advanced keratoconus and to describe its clinical course and management. Although CAIRS implantation is associated with high biocompatibility, extrusion is rarely reported, and its natural history and optimal management remain poorly characterized
Setting
The case was managed at Fundación Oftalmológica Nacional, Bogotá, Colombia, a tertiary referral center specialized in ophthalmology and corneal surgery
Report of case
An 18-year-old patient with advanced keratoconus underwent implantation of two Corneal Allogenic Intrastromal Ring Segments (CAIRS) in the left eye, combined with corneal collagen cross-linking, following published recommendations. Surgery was uneventful, and early follow-up showed proper segment positioning and corneal flattening. At 6 months, focal extrusion of a single segment was observed. Although immediate explantation was advised, the patient declined. Conservative management with frequent topical broad-spectrum antibiotics and systemic matrix metalloproteinase inhibitors, along with close monitoring, was instituted. The graft remained in the tunnel, inflammation resolved, epithelialization occurred over the implant, and adjacent corneal transparency and corneal flattening were preserved
Conclusion/Take home message
Extrusion of a CAIRS implant is an uncommon but recognized complication, even when highly biocompatible allogenic tissue is used. Because CAIRS consists of biologic material, selected cases may be managed conservatively, unlike PMMA intracorneal ring segments, potentially allowing preservation of corneal flattening and corneal transparency. In the present case, the most likely precipitating factor was unconscious eye rubbing during sleep. This observation underscores the importance of assessing and counseling patients regarding eye-rubbing behaviors, as these may increase the risk of implant extrusion even when highly biocompatible graft tissue is employed