: Corneal melt is a rare complication of ICRS. We conclude that wound gape over ICRS contributes to the development of melt. Strategies can be employed to reduce the incidence of this rare but important complications of ICRS.

Treatment for keratoconus (KC) has traditionally been limited to gas-permeable lenses until visual acuity becomes inadequate or the patient becomes intolerant to the lenses. At this point, a penetrating keratoplasty was indicated. Intracorneal ring segments (Intacs) represent a new treatment of KC. The placement and dimensions of the Intacs implants help to reshape the cornea, thus normalizing the cornea's architecture and adjusting for the myopia and irregular astigmatism caused by KC. Intacs segment specifications for Wang Vision Institute bladeless IntraLase surgical insertion is 0.350 mm thick (the largest size) to maximize the corneal strengthening effect with an arc length of 150 degrees. We typically use a single segment, placed such that it traverses the area of steepest curvature on an axial topographical map. Programming of the IntraLase femtosecond laser, operation of the docking system, and usage of the instruments will be reviewed. Intraoperative complications and management of the lamellar channel creation, Intacs insertion, and postoperative instructions are discussed. The advantages of IntraLase compared with manual channel include a safer and shorter surgical procedure, minimal surgical manipulation, less chance of anterior chamber perforation while preparing the channel, more controlled and accurate dimensions of the channel within 5 to 10 2m, a faster recovery after surgery, and minimal pain and discomfort. | HISTORICAL PERSPECTIVEKeratoconus (KC) and pellucid marginal degeneration (PMD) are progressive corneal degenerations characterized by asymmetric bilateral corneal thinning in most cases. The etiology of KC includes degeneration of epithelial cells followed by breaks in the Bowman layer, releasing degradative enzymes. 1 These enzymes cause an increase in collagenase activity, thus breaking down stromal collagen and resulting in stromal thinning. Pellucid marginal degeneration etiology is not well established, but collagen abnormalities are also present. 2 Both conditions result in corneal distortion and, therefore, reduced vision. Because of the irregular astigmatism, these patients cannot be adequately corrected with spectacles or soft contact lenses.Historically, management of KC and PMD was limited to gas-permeable contact lenses followed by penetrating keratoplasty at the advanced stages. However, penetrating keratoplasty is associated with significant risks, including intraocular surgery risk, endothelial cell loss during the procedure, long period of rehabilitation, prolonged use of steroids and glaucoma risk, anisometropia, irregular astigmatism, and graft rejection. To address the corneal wall weakening of these ecstatic conditions, procedures have been developed to treat KC/PMD by reinforcing the strength of the cornea. These procedures include epikeratoplasty and lamellar keratoplasty.Intracorneal ring segments (Intacs; Intacs Addition Technology, Inc, Des Plaines, Ill) represent a new treatment of KC/PMD by both tissue-additive and tissuetenting effects. The expansion of the seg...