Corneal infiltration due to late endothelial perforation by an intrastromal ring segment

Intrastromal rings have a high safety profile, with late complications being rare. A clinical case is presented of a patient who attended the emergency department due to photophobia and redness in the right eye with a two-day onset. A relevant medical history includes the implantation of an intrastromal corneal ring segment for keratoconus 11 years earlier. Examination revealed a deep whitish stromal infiltration around the ring. After several weeks of antibiotic treatment, the decision was made to explant the ring. Preoperative OCT demonstrated endothelial perforation at the site of the infiltration. Aqueous humour leakage was observed upon removal of the ring segment. The patient reported notable symptomatic improvement following surgery. We present a rare complication following the implantation of an intrastromal ring, initially suspected to be a stromal infiltration, which turned out to be an unusually late endothelial perforation.