Surgical Management Of Advanced Keratoconus Using Concentric 320 Intracorneal Ring Segments: A Case Report

 To report the clinical outcome of a young patient with advanced keratoconus treated with the implantation of two concentric 320-degree intrastromal corneal ring segments (ICRS) in different optical zones as an alternative to corneal transplantation.

Tertiary referral ophthalmology center.

 A 17-year-old female with a three-year history of progressive visual loss in the right eye was evaluated. Uncorrected visual acuity was counting fingers at 1 meter in the right eye and 20/50 in the left eye, with best-corrected visual acuity of 20/150 and 20/20, respectively. Corneal tomography revealed a Kmax of 89.6 D in the right eye. After unsatisfactory visual outcomes with scleral contact lenses, simultaneous implantation of two 320-degree ICRS was performed in concentric positions at 5 mm and 6 mm optical zones using femtosecond laser assistance.  At three months postoperatively, the patient demonstrated marked improvement in visual acuity, achieving 20/100 with spectacles and 20/30 with scleral contact lenses in the right eye. Corneal topography showed substantial improvement, with Kmax reduced to 68.2 D. No intraoperative or postoperative complications were observed.

 The implantation of two concentric 320-degree intrastromal corneal ring segments in different optical zones proved to be a safe and effective option for visual rehabilitation in advanced keratoconus. This approach promoted corneal stabilization, improved keratometric parameters, and postponed the need for corneal transplantation, particularly in young patients at higher risk for graft-related complications.