Dovepress Abbott Park, IL) was used to create intrastromal channels for ICRS at a depth of 370 µm, with inner and outer diameters of 5.0 and 5.6 mm, respectively. A disposable suction ring and an applanation cone were used to stabilize and flatten the cornea to maintain a precise distance from the laser head to the focal point. The pulse duration was 600 fs. The femtosecond laser settings were as follows: entry cut thickness, 1 µm; ring energy, 1.50–2.50 µJ; and entry cut energy 1.50 µJ. Since the inferior cornea was thinner than the depth of the planned intrastromal channels, a novel technique had to be developed to prevent the penetration of the femtosecond laser beam into the anterior chamber. Thus, a piece of gelatinous paper was placed into the applanation cone of the femtosecond laser, at the area corresponding to the extremely thin inferior segment, which prevented the femtosecond laser beam from passing through. In this way, a C-shaped intrastromal channel with an inferior opening was created instead of a full circle (Figure 2A). This allowed the implantation of the ICRS as in routine procedures with no additional technical difficulties, while protecting the anterior segment structures inferiorly (see Supplementary video, available here). Postoperatively, topical ofloxacin 0.3% (Exocin®; Allergan, Mougins, France) four times daily and predniso- lone acetate 1% eye drops (PredForte®; Allergan, Mougins, France) four times daily were used for 1 week. The steroid eye drop was tapered over 3 weeks. Preservative-free artificial tear (Refresh plus®; Allergan, Irvine, CA, USA) eye drops were used as needed. Intracorneal ring implantation using Intralase® Postoperative course In his examination 1 month postoperation, the patient’s UCVA was 0.05 and his BCVA had improved to 0.6 with a manifest refraction of +3.00 (−4.50 × 45°). Slit-lamp examination revealed well-centered intracorneal rings with no migration or inflammatory reaction (Figure 2B). In Orbscan II® topog- raphy, minimum and maximum simulated K readings were 42.3 D and 38.5 D, respectively (Figure 3). Visante® (Carl Zeiss Meditec Inc, Dublin, CA) anterior segment optical coherence tomography displayed that the intrastromal chan- nels were created at a depth of ∼370 µm. No signs of damage to the anterior segment structures were noted. In his examination at 1 year postoperation, his UCVA was 0.1 and BCVA was 0.7, with a manifest refraction of +1.50 (–3.50 × 35°) in the operated eye. Discussion Eyes affected by alkali burn are often complicated by limbal stem-cell insufficiency and dry eye, persistent epithelial defects, stromalysis, and even perforation.7–9 Penetrating keratoplasty (PK) poses technical difficulties in these eyes due to irregularly thinned corneas and high risk for graft rejection due to stem-cell insufficiency, corneal neovascular- ization, and dry eye. Corneal grafting should be deferred until a healthy ocular surface with no inflammation is achieved. ICRS implantations have been successfully implemented for the rehabilitation of primary corneal ectasias such as keratoconus and pellucid corneal marginal degenerations3,4,6 Figure 2 (A) Intraoperative image of intrastromal channel creation with femtosecond laser; inferior half of the cone was covered by a gelatinous paper. (B) Postoperative first-month slit-lamp image of the cornea showing the inferiorly thin and vascularized cornea and temporal and nasal placement of the intracorneal ring segments. Clinical Ophthalmology 2011:5 submit your manuscript | www.dovepress.com Dovepress 1633