A practical and efficient technique for corneal allogenic ring segment implantation: prolene suture-guided insertion

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Keratoconus and other corneal ectasias require advanced surgical interventions.
• Corneal allogenic intrastromal ring segment (CAIRS) implantation is a minimally invasive option for managing corneal ectasia.
• Accurate and secure implantation of CAIRS is crucial for successful outcomes.

Purpose of the Study:

• To detail a practical and efficient prolene suture-guided technique for CAIRS implantation.
• To assess intraoperative challenges and complications associated with this specific technique.
• To evaluate the feasibility of implanting wider allogenic segments without dehydration.

Main Methods:

• Retrospective review of medical records and surgical videos of patients undergoing CAIRS.
• Standardized femtosecond laser parameters and donor ring preparation from residual corneal tissue.
• Utilized a 5-0 prolene suture passed through Bowman's layer to guide ring insertion into a narrow stromal tunnel.

Main Results:

• Twenty-three eyes of 23 patients were included; 78.3% had combined CAIRS and collagen cross-linking (CXL).
• Four cases (17.4%) experienced intraoperative complications, exclusively due to prolene suture disengagement.
• Re-passing the suture successfully restored guidance, enabling successful implantation in all cases.

Conclusions:

• The prolene suture-guided technique is a practical and reproducible refinement for CAIRS surgery.
• This method facilitates the implantation of allogenic segments, addressing a technically challenging aspect of the procedure.
• CAIRS remains a customizable and minimally invasive treatment for corneal ectasia, enhanced by this guided technique.