Intracorneal ring implantation using Intralase® with partial coverage of the cone in a patient after an alkaline injury

PURPOSE: To report the use of intracorneal ring segment (ICRS) implantation in a case of severe corneal thinning and irregularity secondary to alkali burn. CASE REPORT: A 33-year-old man who had a history of ocular alkali burn in the right eye was admitted. His best corrected visual acuity was 0.16 with manifest refraction of +5.00 (–7.00 × 180°). Orbscan II(®) revealed steepening of >53 D superiorly, excessive thinning inferiorly with thinnest pachymetric reading of 269 μm. Two KeraRing(®) segments, 200 μm thick and 90° arced, were implanted. During intrastromal channel creation by Intralase(®), the inferior half of the applanating cone was covered by a gelatinous paper to prevent the penetration of the laser beam into the anterior chamber. In the first year postoperation, best corrected visual acuity was 0.7 with manifest refraction of +1.50 (–3.50 × 35°). Visante(®) opticial coherence tomography displayed ICRS at a depth of <370 μm. CONCLUSION: ICRS implantation with this novel approach may be an option in eyes with severe corneal irregularity and thinning.