Skip to main content
SpringerLink
Log in

Intracorneal Ring Segments in Keratoconus

  • Chapter
  • First Online:
Keratoconus

  • 382 Accesses

Abstract

Intracorneal ring segments (ICRS) implantation was proposed as a surgical procedure for the management of keratoconus almost 20 years ago. Since then, several studies have not only reported on the efficacy and safety of this therapeutic option but also focused on their effects on normal and keratoconic corneas. Nowadays, ICRS implantation constitutes a minimal invasive, safe, and reversible surgical option in patients with keratoconus and contact lens intolerance, which can delay or sometimes avoid corneal grafting. They can improve the refractive, visual, and topographic outcomes in patients with keratoconus by changing the shape of highly distorted corneas, enhancing corneal topographic regularization, and restoring corneal biomechanical properties. In this chapter, we aim to provide a review on the most significant aspects of ICRS, including the various types of ICRS, their mechanism of action, clinical outcomes, and complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Barraquer JI. Modification of refraction by means of intracorneal inclusions. Int Ophthalmol Clin. 1966;6(1):53–78.

    Article  CAS  PubMed  Google Scholar 

  2. Burris TE. Intrastromal corneal ring technology: results and indications. Curr Opin Ophthalmol. 1998;9(4):9–14.

    Article  CAS  PubMed  Google Scholar 

  3. Blavatskaia DE. The use of intralamellar homoplasty in order to reduce refraction of the eye. Uberstzt Aus Oftalmol Zh. 1966;7:530–7.

    Google Scholar 

  4. Fleming JF, Reynolds AE, Kilmer L, Burris TE, Abbott RL, Schanzlin DJ. The intrastromal corneal ring: two cases in rabbits. J Refract Surg. 1987;3(6):227–32.

    Article  Google Scholar 

  5. Burris TE, Baker PC, Ayer CT, Loomas BE, Mathis ML, Silvestrini TA. Flattening of central corneal curvature with intrastromal corneal rings of increasing thickness: an eye-bank eye study. J Cataract Refract Surg. 1993;19(Suppl):182–7.

    Article  PubMed  Google Scholar 

  6. Twa MD, Karpecki PM, King BJ, Linn SH, Durrie DS, Schanzlin DJ. One-year results from the phase III investigation of the KeraVision Intacs. J Am Optom Assoc. 1999;70(8):515–24.

    CAS  PubMed  Google Scholar 

  7. Colin J, Cochener B, Savary G, Malet F. Correcting keratoconus with intracorneal rings. J Cataract Refract Surg. 2000;26(8):1117–22.

    Article  CAS  PubMed  Google Scholar 

  8. Alió JL, Shabayek MH, Artola A. Intracorneal ring segments for keratoconus correction: long-term follow-up. J Cataract Refract Surg. 2006;32(6):978–85.

    Article  PubMed  Google Scholar 

  9. Alió JL, Shabayek MH, Belda JI, Correas P, Feijoo ED. Analysis of results related to good and bad outcomes of Intacs implantation for keratoconus correction. J Cataract Refract Surg. 2006;32(5):756–61.

    Article  PubMed  Google Scholar 

  10. Kymionis GD, Siganos CS, Tsiklis NS, Anastasakis A, Yoo SH, Pallikaris AI, Astyrakakis N, Pallikaris IG. Long-term follow-up of Intacs in keratoconus. Am J Ophthalmol. 2007;143(2):236–44.

    Article  PubMed  Google Scholar 

  11. Zare MA, Hashemi H, Salari MR. Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy. J Cataract Refract Surg. 2007;33(11):1886–91.

    Article  PubMed  Google Scholar 

  12. Krumeich JH, Daniel J. Lebend-Epikeratophakie und Tiefe Lamelläre Keratoplastik zur Stadiengerechten chirurgischen Behandlung des Keratokonus (KK) I-III [live epikeratophakia and deep lamellar keratoplasty for I-III stage-specific surgical treatment of keratoconus]. Klin Monatsbl Augenheilkd. 1997;211(2):94–100.

    Article  CAS  PubMed  Google Scholar 

  13. Ertan A, Bahadir M. Management of superior pellucid marginal degeneration with a single intracorneal ring segment using femtosecond laser. J Refract Surg. 2007;23(2):205–8.

    Article  PubMed  Google Scholar 

  14. Kymionis GD, Tsiklis NS, Pallikaris AI, Kounis G, Diakonis VF, Astyrakakis N, Siganos CS. Long-term follow-up of Intacs for post-LASIK corneal ectasia. Ophthalmology. 2006;113(11):1909–17.

    Article  PubMed  Google Scholar 

  15. Djotyan GP, Kurtz RM, Fernández DC, Juhasz T. An analytically solvable model for biomechanical response of the cornea to refractive surgery. J Biomech Eng. 2001;123(5):440–5.

    Article  CAS  PubMed  Google Scholar 

  16. Fleming JF, Wan WL, Schanzlin DJ. The theory of corneal curvature change with the intrastromal corneal ring. CLAO J. 1989;15(2):146–50.

    CAS  PubMed  Google Scholar 

  17. Patel S, Marshall J, Fitzke FW 3rd. Model for deriving the optical performance of the myopic eye corrected with an intracorneal ring. J Refract Surg. 1995;11(4):248–52.

    Article  CAS  PubMed  Google Scholar 

  18. Kling S, Marcos S. Finite-element modeling of intrastromal ring segment implantation into a hyperelastic cornea. Invest Ophthalmol Vis Sci. 2013;54(1):881–9.

    Article  PubMed  Google Scholar 

  19. Fares U, Otri AM, Al-Aqaba MA, Dua HS. Correlation of central and peripheral corneal thickness in healthy corneas. Cont Lens Anterior Eye. 2012;35(1):39–45.

    Article  PubMed  Google Scholar 

  20. Burris TE, Holmes-Higgin DK, Silvestrini TA, Scholl JA, Proudfoot RA, Baker PC. Corneal asphericity in eye bank eyes implanted with the intrastromal corneal ring. J Refract Surg. 1997;13(6):556–67.

    Article  CAS  PubMed  Google Scholar 

  21. Torquetti L, Cunha P, Luz A, Kwitko S, Carrion M, Rocha G, Signorelli A, Coscarelli S, Ferrara G, Bicalho F, Neves R, Ferrara P. Clinical outcomes after implantation of 320°-arc length intrastromal corneal ring segments in keratoconus. Cornea. 2018;37(10):1299–305.

    Article  PubMed  Google Scholar 

  22. Zare MA, Mehrjardi HZ, Afarideh M, Bahrmandy H, Mohammadi SF. Visual, Keratometric and corneal biomechanical changes after Intacs SK implantation for moderate to severe keratoconus. J Ophthalmic Vis Res. 2016;11(1):17–25.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Roberts CJ. Biomechanics in Keratoconus. In: Barbara A, editor. Textbook on Keratoconus: new insights. Jaypee Brothers Medical Publishers (P) Ltd.; 2012. p. 29–32.

    Chapter  Google Scholar 

  24. Burris TE, Ayer CT, Evensen DA, Davenport JM. Effects of intrastromal corneal ring size and thickness on corneal flattening in human eyes. Refract Corneal Surg. 1991;7(1):46–50.

    Article  CAS  PubMed  Google Scholar 

  25. Cristina Kenney M, Brown DJ. The cascade hypothesis of keratoconus. Cont Lens Anterior Eye. 2003;26(3):139–46.

    Article  CAS  PubMed  Google Scholar 

  26. Ku JY, Niederer RL, Patel DV, Sherwin T, McGhee CN. Laser scanning in vivo confocal analysis of keratocyte density in keratoconus. Ophthalmology. 2008;115(5):845–50.

    Article  PubMed  Google Scholar 

  27. Akhtar S, Bron AJ, Salvi SM, Hawksworth NR, Tuft SJ, Meek KM. Ultrastructural analysis of collagen fibrils and proteoglycans in keratoconus. Acta Ophthalmol. 2008;86(7):764–72.

    Article  PubMed  Google Scholar 

  28. Daxer A, Fratzl P. Collagen fibril orientation in the human corneal stroma and its implication in keratoconus. Invest Ophthalmol Vis Sci. 1997;38(1):121–9.

    CAS  PubMed  Google Scholar 

  29. Samimi S, Leger F, Touboul D, Colin J. Histopathological findings after intracorneal ring segment implantation in keratoconic human corneas. J Cataract Refract Surg. 2007;33(2):247–53.

    Article  PubMed  Google Scholar 

  30. Ruckhofer J, Böhnke M, Alzner E, Grabner G. Confocal microscopy after implantation of intrastromal corneal ring segments. Ophthalmology. 2000;107(12):2144–51.

    Article  CAS  PubMed  Google Scholar 

  31. Twa MD, Ruckhofer J, Kash RL, Costello M, Schanzlin DJ. Histologic evaluation of corneal stroma in rabbits after intrastromal corneal ring implantation. Cornea. 2003;22(2):146–52.

    Article  PubMed  Google Scholar 

  32. Kim WJ, Rabinowitz YS, Meisler DM, Wilson SE. Keratocyte apoptosis associated with keratoconus. Exp Eye Res. 1999;69(5):475–81.

    Article  CAS  PubMed  Google Scholar 

  33. Alió JL, Artola A, Ruiz-Moreno JM, Hassanein A, Galal A, Awadalla MA. Changes in keratoconic corneas after intracorneal ring segment explantation and reimplantation. Ophthalmology. 2004;111(4):747–51.

    Article  PubMed  Google Scholar 

  34. Siganos D, Ferrara P, Chatzinikolas K, Bessis N, Papastergiou G. Ferrara intrastromal corneal rings for the correction of keratoconus. J Cataract Refract Surg. 2002;28(11):1947–51.

    Article  PubMed  Google Scholar 

  35. Prisant O, Pottier E, Guedj T, Hoang XT. Clinical outcomes of an asymmetric model of intrastromal corneal ring segments for the correction of keratoconus. Cornea. 2020;39(2):155–60.

    Article  PubMed  Google Scholar 

  36. Ertan A, Colin J. Intracorneal rings for keratoconus and keratectasia. J Cataract Refract Surg. 2007;33(7):1303–14.

    Article  PubMed  Google Scholar 

  37. Daxer A. Biomechanics of corneal ring implants. Cornea. 2015;34(11):1493–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kymionis GD. Actual indications for intracorneal ring segment implantation in keratoconus. In: Güell JL, editor. Cornea, ESASO Course Series, vol. 6. Basel: Karger; 2015. p. 66–73.

    Chapter  Google Scholar 

  39. Vega-Estrada A, Alio JL. The use of intracorneal ring segments in keratoconus. Eye Vis (Lond). 2016;3:8.

    Article  Google Scholar 

  40. Ertan A, Kamburoğlu G. Intacs implantation using a femtosecond laser for management of keratoconus: comparison of 306 cases in different stages. J Cataract Refract Surg. 2008;34(9):1521–6.

    Article  PubMed  Google Scholar 

  41. Shetty R, D'Souza S, Ramachandran S, Kurian M, Nuijts RM. Decision making nomogram for intrastromal corneal ring segments in keratoconus. Indian J Ophthalmol. 2014;62(1):23–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rocha G, Silva LNP, Chaves LFOB, Bertino P, Torquetti L, de Sousa LB. Intracorneal ring segments implantation outcomes using two different Manufacturers' nomograms for keratoconus surgery. J Refract Surg. 2019;35(10):673–83.

    Article  PubMed  Google Scholar 

  43. Sharma M, Boxer Wachler BS. Comparison of single-segment and double-segment Intacs for keratoconus and post-LASIK ectasia. Am J Ophthalmol. 2006;141(5):891–5.

    Article  PubMed  Google Scholar 

  44. Alió JL, Artola A, Hassanein A, Haroun H, Galal A. One or 2 Intacs segments for the correction of keratoconus. J Cataract Refract Surg. 2005;31(5):943–53.

    Article  PubMed  Google Scholar 

  45. Rabinowitz YS. INTACS for keratoconus. Int Ophthalmol Clin. 2006;46(3):91–103.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ibrahim TA. After 5-years follow-up: do Intacs help in keratoconus. J Cataract Refract Surg. 2006;1:45–8.

    Google Scholar 

  47. Shetty R, Kurian M, Anand D, Mhaske P, Narayana KM, Shetty BK. Intacs in advanced keratoconus. Cornea. 2008;27(9):1022–9.

    Article  PubMed  Google Scholar 

  48. Hellstedt T, Mäkelä J, Uusitalo R, Emre S, Uusitalo R. Treating keratoconus with intacs corneal ring segments. J Refract Surg. 2005;21(3):236–46.

    Article  PubMed  Google Scholar 

  49. Colin J, Cochener B, Savary G, Malet F, Holmes-Higgin D. INTACS inserts for treating keratoconus: one-year results. Ophthalmology. 2001;108(8):1409–14.

    Article  CAS  PubMed  Google Scholar 

  50. Benoist d'Azy C, Pereira B, Chiambaretta F, Dutheil F. Efficacy of different procedures of intra-corneal ring segment implantation in keratoconus: a systematic review and meta-analysis. Transl Vis Sci Technol. 2019;8(3):38.

    Article  PubMed  Google Scholar 

  51. Piñero DP, Alio JL. Intracorneal ring segments in ectatic corneal disease - a review. Clin Exp Ophthalmol. 2010;38(2):154–67.

    Article  PubMed  Google Scholar 

  52. Bautista-Llamas MJ, Sánchez-González MC, López-Izquierdo I, López-Muñoz A, Gargallo-Martínez B, De-Hita-Cantalejo C, Sánchez-González JM. Complications and Explantation reasons in Intracorneal ring segments (ICRS) implantation: a systematic review. J Refract Surg. 2019;35(11):740–7.

    Article  PubMed  Google Scholar 

  53. Rabinowitz YS, Li X, Ignacio TS, Maguen E. INTACS inserts using the femtosecond laser compared to the mechanical spreader in the treatment of keratoconus. J Refract Surg. 2006;22(8):764–71.

    Article  PubMed  Google Scholar 

  54. Kubaloglu A, Sari ES, Cinar Y, Cingu K, Koytak A, Coşkun E, Ozertürk Y. Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: prospective randomized clinical trial. J Cataract Refract Surg. 2010;36(9):1556–61.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital “G. Gennimatas”, Athens, Greece

    Andreas Katsimpris & George Kymionis

Authors
  1. Andreas Katsimpris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Kymionis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Katsimpris .

Editor information

Editors and Affiliations

  1. L V Prasad Eye Institute, Bhubaneswar, Odisha, India

    Sujata Das

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Katsimpris, A., Kymionis, G. (2022). Intracorneal Ring Segments in Keratoconus. In: Das, S. (eds) Keratoconus. Springer, Singapore. https://doi.org/10.1007/978-981-19-4262-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-4262-4_17

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-4261-7

  • Online ISBN: 978-981-19-4262-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation