Cakir et al from nonprogressive loss of vision since then. At time of admission, his uncorrected visual acuity (UCVA) enabled him to count fingers held up at a distance of 2 m away. His best corrected visual acuity (BCVA) was 0.16 in Snellen lines, with a manifest refraction of +5.00 (−7.00 × 180°). The patient was emmetropic in the left eye, with a UCVA of 1.0. He mentioned that vision in his right eye had been the same as in his left eye before the injury. His medical records from the center where he had received immediate first aid eye care for the management of alkali burn showed that his UCVA and BCVA had remained stable since the injury. The potential visual acuity, assessed by placing a rigid contact lens over his eye, revealed a BCVA of 0.3. Orbscan® II (Bausch & Lomb, Rochester, NY) topography revealed that severe corneal thinning was present inferiorly with excessive steepening in the superior quadrants. The minimum and maximum simulated K readings were 42.1 D and 48.6 D, respectively; however, steepening in the superior quadrants reached .53 D. The central and thinnest pachymetric readings were 358 µm and 269 µm, respectively, with a reverse keratectasia pattern (Figure 1). The corneal Dovepress transparency was not affected centrally, but, as a consequence of localized limbal stem cell deficiency, perilimbal opacifica- tion and corneal neovascularization were noted inferiorly. The intraocular pressure was 16 mmHg and fundus examination was unremarkable. In an attempt to improve the vision, ICRS (KeraRing®, Mediphacos Ltda, Belo Horizonte, Brazil) implantation was planned for the correction of the corneal steepening and irregu- larity. Two segments with 200 µm thickness and 90° arcs were to be placed temporally and nasally, where corneal thicknesses were greater than 400 µm. The patient was given detailed information about the planned surgery; its possible risks and complications, particularly those that were relevant to his unique corneal characteristics; and possible modifications of the surgical technique. Written informed consent was obtained from the patient before any procedures were performed. surgical technique The pachymetric readings were confirmed by ultrasonic pachymetry prior to the surgery. The femtosecond laser keratome (Intralase®, Advanced Medical Optics, Inc, Figure 1 Patient’s preoperative Orbscan II® corneal topography imaging information. 1632 submit your manuscript | www.dovepress.com Dovepress Clinical Ophthalmology 2011:5