Intrastromal corneal ring segments for post-LASIK ectasia complicated by persistent pain

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery

Background:

• Corneal ectasia is a progressive thinning and bulging of the cornea, often occurring after refractive surgery like laser in situ keratomileusis (LASIK).
• Intrastromal corneal ring segments (ICRS) are used to regularize the corneal shape and improve visual acuity in patients with corneal ectasia, especially those intolerant to contact lenses.

Observation:

• A 33-year-old male, 2 years post-LASIK, developed corneal ectasia and was contact lens intolerant.
• ICRS (Intacs) were implanted in his right eye, initially improving visual acuity and reducing corneal elevation.
• Persistent ocular pain developed post-ICRS implantation, diagnosed via confocal microscopy as corneal nerve contact with the superonasal ring segment.

Findings:

• ICRS implantation successfully corrected refractive errors and improved visual function in a post-LASIK ectasia patient.
• Corneal nerve interaction with implanted ICRS can lead to significant, persistent ocular pain.
• Surgical removal of the offending ICRS segment effectively resolved the patient's pain.

Implications:

• This case highlights the importance of considering potential corneal nerve complications during and after ICRS implantation.
• Careful preoperative assessment and postoperative monitoring are crucial for managing patients undergoing ICRS for post-LASIK ectasia.
• ICRS removal is a viable option for managing persistent pain associated with corneal nerve impingement.