Importance Of Anterior Segment Oct In The Follow-Up Of Intrastromal Corneal Ring Segments: A Case Of Extrusion Following Anterior Uveitis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR349 | Type: Poster | DOI: 10.82333/qbxd-py12
Authors: Patricia García Carrero* 1 , Mr Luis Alcalde Blanco 1 , Ana Isabel Palacios Hipola 1 , Alfonso Andrés Iribarra Fermandois 1 , Beatriz Sarmiento Torres 1 , María Jesús Suárez Fernández 1
1Ophthalmology,Hospital 12 de Octubre,Madrid,Spain
Purpose
To report a rare postoperative complication following femtosecond laser–assisted implantation of an intrastromal corneal ring segment (ICRS) in a patient with keratoconus and thin cornea, and to highlight the role of anterior segment optical coherence tomography (AS-OCT) in the early detection of progressive ring superficialization preceding extrusion.
Setting
Anterior segment and cornea unit, Hospital Universitario 12 de Octubre (Madrid, Spain), a tertiary referral academic hospital.
Methods
Follow-up of a 27-year-old patient with bilateral grade 3–4 keratoconus and thin corneas who underwent uncomplicated femtosecond laser–assisted implantation of an intrastromal corneal ring segment (ICRS) Keraring in the left eye. Five months later, the same procedure was performed in the right eye. Postoperative monitoring included distance visual acuity, autorefraction, slit-lamp biomicroscopy, Scheimpflug corneal tomography (Pentacam) and anterior segment optical coherence tomography (AS-OCT).
Results
One week postoperatively, right eye AS-OCT showed stable ICRS depth (242 µm) and keratometry improved at one month. At 6 weeks, the patient developed acute anterior uveitis, treated with topical steroids and cycloplegics. One month later, uveitis recurred with a tunnel infiltrate. Despite intensive topical antibiotics and steroids, 72 hours later she presented tunnel fluorescein staining and severe anterior chamber inflammation. AS-OCT revealed a progressive ICRS superficialization of 100 µm. Due to clinical worsening, surgical explantation confirmed spontaneous superior ICRS extrusion. Microbiological cultures were negative.The patient remains stable under follow-up.
Conclusions
Extrusion of intrastromal corneal ring segments is uncommon with femtosecond technology. AS-OCT is an indispensable tool in postoperative surveillance, allowing objective monitoring of ring depth and early detection of anterior migration. Furthermore, episodes of anterior segment inflammation, such as uveitis, may act as precursors or indicators of stromal melting. In these cases, AS-OCT is crucial to guide timely clinical management before frank extrusion occurs.