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

Patient: Male, 17-year-old Final Diagnosis: Acute corneal hydrops • intrastromal corneal ring segment migration Symptoms: Poor visual acuity • rigid contact lens intolerance Medication: — Clinical Procedure: Intrastromal corneal ring segment implantation • intrastromal corneal ring segment reimplantation Specialty: Ophthalmology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: 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. CASE REPORT: 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. CONCLUSIONS: 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.