Mastering Keratoconic Hydrops: 5-Year Outcomes Of Intrastromal Support With A 320-Degree Ferrara Ring

To report the 5-year structural and visual outcomes of femtosecond laser-assisted 320-degree Ferrara Ring implantation in a 28-year-old professional football coach with a history of keratoconic hydrops. Managing post-hydrops corneas presents a unique clinical challenge due to extreme biomechanical instability. This study aims to evaluate how extensive 320-degree intrastromal support can successfully flatten the highly irregular cornea, halt ectatic progression, and provide a minimally invasive solution that allows a young patient to resume a high-impact athletic lifestyle without the risks associated with corneal grafting.

Specialized private cornea and refractive surgery practice, fully equipped with advanced anterior segment diagnostic modalities and femtosecond laser capabilities for complex corneal ectasia management.

A 28-year-old male, a professional football coach and active athlete (football and tennis), presented with keratoconic hydrops. His medical history was unremarkable. Comprehensive diagnostic evaluation included detailed slit-lamp clinical examination, Schirmer test, Scheimpflug topography (Pentacam), and Anterior Segment OCT (AS-OCT). Following the initial management and resolution of the acute hydrops phase, a single 320-degree Ferrara Ring was implanted using a femtosecond laser. The goal was to provide intense 360-degree structural support, flatten the highly irregular cornea, and halt ectasia progression without restricting his demanding athletic lifestyle.

The 5-year follow-up revealed remarkable structural and visual stabilization. AS-OCT confirmed the stable deep stromal position of the 320-degree Ferrara ring and complete resolution of stromal edema with favorable, minimal scar remodeling. Pentacam topography demonstrated a significant, sustained reduction in maximum keratometry (Kmax). The patient experienced dramatic improvements in both uncorrected (UDVA) and corrected distance visual acuity (CDVA). Notably, this structural and visual recovery allowed him to fully resume his professional coaching and contact sports activities without any restrictions. No ring extrusion, migration, or other long-term complications occurred.

The implantation of a 320-degree Ferrara Ring offers a robust, safe, and highly effective long-term surgical solution for stabilizing corneas after keratoconic hydrops. It successfully halts ectatic progression, significantly improves visual function, and provides a powerful alternative to penetrating or deep anterior lamellar keratoplasty (PKP/DALK). Crucially, this minimally invasive approach enables young, highly active patients to safely return to demanding athletic careers with excellent long-term stability. Furthermore, the 5-year follow-up confirms that extensive intrastromal support effectively manages severe biomechanical weakness, shifting the treatment paradigm away from early grafting.