Advancing Keratoconus Management—Restoration of Visual Acuity with Concentric 320 Intracorneal Ring Segments: A Case Report

Introduction: Keratoconus is a progressive ectatic disorder that causes corneal thinning and protrusion, leading to irregular astigmatism and significant visual impairment.It typically affects patients in their teens or early adulthood, and in advanced stages, contact lenses or corneal transplants may be required.Intracorneal ring segments (ICRSs) are an effective alternative, especially the 320 arc-shaped rings, which help stabilize the cornea by flattening it and improving visual outcomes.Case description: A 17-year-old female with advanced keratoconus presented with progressive visual acuity loss in her right eye over 3 years.Initial examination revealed visual acuity of 20/150 in the right eye and 20/20 in the left.After the failure of scleral contact lenses, two 320 ICRS were implanted in concentric positions at 5 mm and 6 mm optical zones.Three months post-surgery, corrected visual acuity improved to 20/100 in the right eye and 20/30 with scleral lenses.Keratometry values also improved significantly.Discussion: Intracorneal ring segment implantation is a well-established method for treating keratoconus, especially in cases where a corneal transplant is considered.The procedure reshapes the cornea, improving vision and reducing astigmatism.The use of femtosecond lasers enhances the precision of ICRS placement, reducing complications.The two concentric ring approach, using 320 arc-shaped rings, provides significant corneal remodeling and better visual outcomes while avoiding more invasive procedures like corneal transplants.Conclusion: Intracorneal ring segments, particularly with the two-ring 320 system, offer an effective and less invasive alternative for patients with advanced keratoconus, especially in young patients.This case illustrates how ICRS can improve both corneal topography and visual acuity, providing a viable solution to avoid corneal transplantation.