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Corneal hydrops after intrastromal corneal ring segment implantation

Kaya, Vedat MD; Kaynak, Pelin MD; Basarir, Berna MD

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Journal of Cataract & Refractive Surgery: May 2013 - Volume 39 - Issue 5 - p 816
doi: 10.1016/j.jcrs.2013.03.011
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Although the imaging quality in the article by Güell at el.1 is limited, the corneal topography shows an increase in elevation values inferiorly and superotemporally, steepening in the inferior segment in the keratometric map, and peripheral thinning in the pachymetric map; these are more prominent in the left eye. The topographic pattern may be compatible with peripheral thinning disorders rather than keratoconus.2,3

Multiple pachymetric measurements are needed to determine the minimum thickness of the planned tunnel site prior to intrastromal corneal ring segment (ICRS) implantation. Güell at el. planned ICRS implantation at 400 μm depth; however, they did not mention how they obtained this value. The central corneal thickness (457 μm) was reported, but pachymetric value at the tunnel site, which is crucial for the ophthalmologist to perform this procedure, is not reported. Topographic pachymetry in the left eye was below 300 μm, especially at the 6 o’clock position.

Briefly, in the article there is no evidence of how the authors determined the adequate implantation depth; therefore, there is the possibility of corneal perforation. However, the authors checked whether there was perforation into the anterior chamber by injecting saline solution through the stromal tunnel, proving that there was no perforation. Considering the topographic findings, we think this case is more suggestive of a peripheral thinning disease of the cornea that increases corneal fragility than of keratoconus.


1. Güell JL, Verdaguer P, Elies D, Gris O, Manero F. Acute corneal hydrops after intrastromal corneal ring segment implantation for keratoconus. J Cataract Refract Surg. 2012;38:2192-2195.
2. Karabatsas CH, Cook SD. Topographic analysis in pellucid marginal corneal degeneration and keratoglobus. Eye. 10, 1996, p. 451-455, Available at: Accessed February 23. 2013.
3. Ku JYF, Grupcheva CN, Fisk MJ, McGhee CNJ. Keratoglobus and posterior subcapsular cataract: surgical considerations and in vivo microstructural analysis. J Cataract Refract Surg. 2004;30:237-242.
© 2013 by Lippincott Williams & Wilkins, Inc.