Causes of intrastromal corneal ring segment explantation: clinicopathologic correlation analysis.
OBJECTIVE
To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and the relationship with the microscopic findings on the ICRS surface.


METHODS
Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain.


METHODS
This study evaluated ICRS that were explanted in centers in Spain from 2000 to 2008. Clinical data (reasons for explantation, date of implantation/explantation, tunnel creation technique, ICRS type) and scanning electron microscopy findings on the ICRS surface (adherent tissue-like material, cell deposits, protein) were documented.


RESULTS
Intrastromal corneal ring segments were explanted from 58 eyes (47 patients). The main cause was extrusion (48.2% of explanted segments), followed by refractive failure (ie, poor refractive outcome) (37.9%), keratitis (6.8%; 3.7% culture positive), and corneal melting and perforation (6.8%). Scanning electron microscopy showed cells and cell debris on the ICRS explanted by extrusion, a clean surface on the ICRS explanted for refractive failure, and bacteria (cocci) in the case of proven infectious keratitis.


CONCLUSIONS
The main cause of explantation was extrusion of the ICRS followed by refractive failure. There was a clear correlation between the cause of explantation and the microscopic findings on the ICRS. Extrusion was accompanied by inflammatory cells and cell debris on the ICRS surface. No inflammatory reaction was observed on the ICRS explanted for refractive failure.
Ferrer
Consuelo
C
Vissum Corporation-Instituto Oftalmológico de Alicante, Division of Ophthalmology, Universidad Miguel Hernandez, Alicante, Spain. cferrer@vissum.com
Alió
Jorge L
JL
Montañés
Antonio Uceda
AU
Pérez-Santonja
Jose J
JJ
del Rio
Miguel A Diaz
MA
de Toledo
Juan Alvarez
JA
Teus
Miguel A
MA
Javaloy
Jaime
J
D000293:Adolescent; D000328:Adult; D003316:Corneal Diseases / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants / Q000382:microbiology / Q000648:ultrastructure*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D055815:Young Adult
D019904:Polymethyl Methacrylate