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03 June 2022 : Case report  Mexico

[In Press] Successful Management of Corneal Hydrops and Intrastromal Corneal Ring Segment (ICRS) Migration Following ICRS Implantation for Keratoconus

Unusual or unexpected effect of treatment

Alejandro Ontiveros-Holguín ORCID logo1ADEFG, Jorge Pacheco-Padrón2BDE

DOI: 10.12659/AJCR.936897

Am J Case Rep In Press; DOI: 10.12659/AJCR.936897  

Available online: 2022-06-03, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Acute corneal hydrops refers to a rare complication of keratoconus and other ectatic disorders with potentially sight-threatening sequelae. Intrastromal corneal ring segment (ICRS) implantation is a surgical procedure performed as therapy for keratoconus when there is contact lens intolerance. ICRS migration along the tunnel made for its insertion is one of its most frequent complications. We believe this is the first published case of acute corneal hydrops and ICRS migration unfolding shortly after an uneventful ICRS implantation, and successfully managed with medical treatment and ICRS reimplantation, respectively.
A 17-year-old male, previously diagnosed with bilateral keratoconus 4 years earlier for which he underwent cross-linking surgery for both eyes 3 years prior, presented to our department for a first-time keratoconus assessment. His best-corrected visual acuity (BCVA) was 20/25 OD and 20/40 OS with rigid gas-permeable contact lenses. Due to contact lens intolerance in the OS and lack of custom-fit scleral lenses at the time, 2 ring segments (Ferrara, AJL Ophthalmic, Inc.) with an arc length of 160 degrees and 300 μm in size were implanted at a depth of 320 μm. Within 1 week, severe hydrops and ICRS migration emerged. Medical treatment provided resolution of hydrops and then ICRS reimplantation was performed without further complications, resulting in contact lens tolerance alongside a BCVA of 20/40 OS.
Corneal hydrops is a challenging complication in ICRS implantation due to its infrequent occurrence and the severity of its potential sequelae. Prompt medical treatment and close follow-up are essential to obtain the best outcome in these instances.

Keywords: Corneal Edema; Corneal Topography; Keratoconus; Prostheses and Implants; Refractive Errors; Refractive Surgical Procedures


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923