Safety and effectiveness of intrastromal corneal ring segment implantation at Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia


  • Abdulaziz Alaqsam Department of Cornea and Refractive Surgery, Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia
  • Mohanna AL-Jindan Department of Ophthalmology, Dammam University, Dammam, Saudi Arabia
  • Ammar Almahmod Department of Cornea and Refractive Surgery, Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia
  • Ibrahim Gosadi Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia



Safety, Effectiveness, Intrastromal corneal ring segment, Keratoconus


Background: Intrastromal corneal ring segment (ICRS) implantation is one of the treatment options of keratoconus. This study is aiming to evaluate safety and effectivness of ICRS implantation at Al-Dharan Eye Specialist Hospital.

Methods: This study is a descriptive retrospective case series study. The target population of this study is patients diagnosed with corneal ectasia who underwent ICRS implantation in Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia. Preoperative and postoperative data about uncorrected visual acuity (UCVA), best spectacle–corrected visual acuity (BSCVA), manifest refraction, keratometry, applanation tonometry, corneal topography, and slit-lamp biomicroscopy and indirect ophthalmoscopy were retrieved from medical records of department of Medical Archive. Paired students t-test was used to compare preoperative and postoperative means of study variables.

Results: The total number of recruited patients in this study was 57 patients where 62% of them were males. Sixty-six treated eyes were included in this study where no intra-operative complications were recorded. Upon comparing the mean preoperative data to the mean postoperative data at three months, six months and one year intervals, an overall improvement in the measured outcomes was witnessed. UCVA, BSCVA, and keratometric readings exhibited a statistically significant improvement when comparing preoperative with one-year postoperative findings (p<0.001).

Conclusions: The findings of this study indicate that ICRS implantation is a safe and effective treatment for keratoconus.


Romero-Jimenez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: a review. Contact lens & anterior eye: the journal of the British Contact Lens Association. 2010;33(4):157-66.

Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42(4):297-319.

Gokhale NS. Epidemiology of keratoconus. Indian J Ophthalmol. 2013;61(8):382-3.

Saini JS, Saroha V, Singh P, Sukhija JS, Jain AK. Keratoconus in Asian eyes at a tertiary eye care facility. Clin Experimental Optometry. 2004;87(2):97-101.

Georgiou T, Funnell CL, Cassels-Brown A, O'Conor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye (London, England). 2004;18(4):379-83.

Pearson AR, Soneji B, Sarvananthan N, Sandford-Smith JH. Does ethnic origin influence the incidence or severity of keratoconus? Eye (London, England). 2000;14(Pt 4):625-8.

Assiri AA, Yousuf BI, Quantock AJ, Murphy PJ. Incidence and severity of keratoconus in Asir province, Saudi Arabia. Br J Ophthalmol. 2005;89(11):1403-6.

Al-Towerki AE, Gonnah el S, Al-Rajhi A, Wagoner MD. Changing indications for corneal transplantation at the King Khaled Eye Specialist Hospital (1983-2002). Cornea. 2004;23(6):584-8.

Jhanji V, Sharma N, Vajpayee RB. Management of keratoconus: current scenario. Br J Ophthalmol. 2011;95(8):1044-50.

Koch DD. Refractive surgery for keratoconus: a new approach. J Cataract Refract Surg. 2000;26(8):1099-100.

Sekundo W, Stevens JD. Surgical treatment of keratoconus at the turn of the 20th century. J Refract Surg. 2001;17(1):69-73.

Levinger S, Pokroy R. Keratoconus managed with intacs: one-year results. Arch Ophthalmol. 2005;123(10):1308-14.

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

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

Mahmood MA, Wagoner MD. Penetrating keratoplasty in eyes with keratoconus and vernal keratoconjunctivitis. Cornea. 2000;19(4):468-70.

Kotb AM, Hantera M. Efficacy and safety of Intacs SK in moderate to severe keratoconus. Middle East African J Ophthalmol. 2013;20(1):46-50.

Fahd DC, Jabbur NS, Awwad ST. Intrastromal corneal ring segment SK for moderate to severe keratoconus: a case series. J Refract Surg. 2012;28(10):701-5.

Ganesh S, Shetty R, D'Souza S, Ramachandran S, Kurian M. Intrastromal corneal ring segments for management of keratoconus. Indian J Ophthalmol. 2013;61(8):451-5.

Ertan A, Kamburoglu 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.

Coskunseven E, Kymionis GD, Tsiklis NS, Atun S, Arslan E, Jankov MR, et al. One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus. Am J Ophthalmol. 2008;145(5):775-9.

Gharaibeh AM, Muhsen SM, AbuKhader IB, Ababneh OH, Abu-Ameerh MA, Albdour MD. KeraRing intrastromal corneal ring segments for correction of keratoconus. Cornea. 2012;31(2):115-20.

Jadidi K, Mosavi SA, Nejat F, Naderi M, Janani L, Serahati S. Intrastromal Corneal Ring Segment Implantation (Keraring 355°) in Patients with Central Keratoconus: 6-Month Follow-Up. J Ophthalmol. 2015;2015:8.

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






Original Research Articles