Clinical Ophthalmology Open Access Full Text Article Dovepress open access to scientific and medical research C A s e r e P O r T Intracorneal ring implantation using Intralase ® with partial coverage of the cone in a patient after an alkaline injury Hanefi Cakir1 Canan Asli Utine2 Mehmet Baykara3 1Turkiye Hospital eye Clinic, Istanbul, 2Department of Ophthalmology, Yeditepe University, Istanbul, 3Department of Ophthalmology, Uludag University, Bursa, Turkey Correspondence: Canan Asli Utine Department of Ophthalmology,Yeditepe University, Gazi Umur Pasa sok. No: 28, Besiktas Balmumcu 34349 Istanbul,Turkey Tel +90 533 5587635 Fax +90 212 2112500 email cananutine@gmail.com Purpose: To report the use of intracorneal ring segment (ICRS) implantation in a case of severe corneal thinning and irregularity secondary to alkali burn. Case report: A 33-year-old man who had a history of ocular alkali burn in the right eye was admitted. His best corrected visual acuity was 0.16 with manifest refraction of +5.00 (−7.00 × 180°). Orbscan II® revealed steepening of .53 D superiorly, excessive thinning infe- riorly with thinnest pachymetric reading of 269 µm. Two KeraRing® segments, 200 µm thick and 90° arced, were implanted. During intrastromal channel creation by Intralase®, the inferior half of the applanating cone was covered by a gelatinous paper to prevent the penetration of the laser beam into the anterior chamber. In the first year postoperation, best corrected visual acuity was 0.7 with manifest refraction of +1.50 (−3.50 × 35°). Visante® opticial coherence tomography displayed ICRS at a depth of ∼370 µm. Conclusion: ICRS implantation with this novel approach may be an option in eyes with severe corneal irregularity and thinning. Keywords: alkali burn, ectasia, intrastromal corneal ring segments Introduction The outcome of an ocular alkali burn might range from mild epithelial injury to permanent blindness secondary to destruction of the ocular surface and damage to the intraocular structures.1,2 Once immediate first aid and preventive measures are performed and a quiescent ocular surface with no inflammation is achieved, visual rehabilitation becomes important. Keratoplasty techniques in excessively thinned corneas with limbal stem-cell insufficiency pose unique challenges for surgeons. Intracorneal ring segments (ICRS) have been used with success in the treatment of primary and secondary corneal ectasia.3–6 However, there have been no reports on their use in eyes that have suffered chemical injury. Here, the authors report a patient with corneal thinning and irregularity secondary to alkali burn who underwent ICRS implantation using femtosecond laser keratome, with a novel approach to prevent the penetration of laser shoots through the exces- sively thinned cornea. Case report A 33-year-old man was admitted to Turkiye Hospital in April 2008 complaining of decreased vision in his right eye. In September 2002 he had sustained alkaline chemical injury from caustic soda (sodium hydroxide) in this eye. He had suffered submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/OPTH.S26118 Clinical Ophthalmology 2011:5 1631–1635 © 2011 Cakir et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 1631