Intrastromal rings or Intacs broke into the ophthalmic market with a big bang and was hailed as a savior surgical procedure for Keratoconus patients. The idea is to implant two semi circular rings into the tissue of the cornea on opposite sides of the keratoconic ectasia (protrusion of corneal tissue). The mechanical effect of the Intact rings is to stretch the corneal tissue and in the process flatten the ectasia point of the Keratoconus.

Unfortunately the surgery outcome of the Intrastromal rings hasn’t been as good as expected and very few patients achieve normal functional sight after the procedure. Another complication is post op infections of the procedure as highlighted on this case study.

A 20-year-old woman presented with photophobia, decreased vision, and pain 11 days after uncomplicated implantation of intrastromal corneal ring segments (ICRSs) for keratoconus in both eyes. Bilateral corneal stromal infiltrates were noted at the site of ICRSs implantation. The patient was started on frequent topical fortified antibiotics in both eyes. Despite aggressive medical management, stromal infiltrates progressed, necessitating removal of ICRSs from both corneas to control infectious keratitis and melting of cornea.

Cultures obtained at the time of initial presentation yielded Streptococcus viridans. Patient responded well to the treatment and was left with stromal scars in both corneas.

Although rare, simultaneous implantation of ICRSs may carry a risk of severe bilateral infectious keratitis. Early recognition of infection, aggressive treatment with antibiotics, and, in some cases, removal of ICRSs may be necessary to prevent serious sight-threatening complication of this refractive procedure.

SOURCE: Chaudhry IA, Al-Ghamdi AA, Kirat O, et al. Bilateral Infectious Keratitis After Implantation of Intrastromal Corneal Ring Segments. Cornea. 2010 Jan 21. [Epub ahead of print].