Anterior Stromal Melt With Corneal Allogeneic Intrastromal Ring Segments in a Patient With Severe Atopy

To report the first case of anterior stromal melt after insertion of a corneal allogeneic intrastromal ring segment (CAIRS) in a patient with severe atopy.

A 27-year-old woman with keratoconus, severe atopy, and giant upper tarsal conjunctival papillae underwent uneventful insertion of a CAIRS in her right eye. 4 months later, she presented with severe exacerbation of her atopy, necessitating anti-IgE monoclonal antibody therapy initiation.

Slit-lamp examination revealed thinning of the corneal stroma overlying the CAIRS over a 30-degree sector, also documented by optical coherence tomography. There was a resolution of the giant conjunctival papillae. The patient was started on topical cyclosporine and a tapering loteprednol regimen, along with the anti-IgE treatment. The last follow-up showed stability in visual acuity, stromal thickness, and topographic parameters, which remained better than preoperatively.

Anterior stromal melt, commonly seen with synthetic segments, can rarely develop after CAIRS implantation, in specific circumstances, such as severe inflammation and atopy. Prompt systemic and topical management can potentially stop progression and retain the implanted segment.