• Intrastromal corneal ring segments
• microbial keratitis
• Staphylococcal infection
• keratoconus

Intrastromal corneal ring segments (ICRS) are polymethyl methylacrylate implants placed in the mid-peripheral cornea without destruction or removal of tissue. The displacement of corneal lamellae produces shortening of the central corneal arc length and flattening of the central cornea.1 It is for this reason that there has been interest in the use of ICRS for the treatment of myopia and, more recently, keratoconus.

The benefits of ICRS over some other refractive procedures include reversibility or potential for adjustment; sparing of the central cornea; maintenance of the positive asphericity of the cornea and, in the case of keratoconus, potential to delay or obviate the need for corneal transplantation.2 However, as with all biomedical implants, infection remains a risk.

We report a case of microbial keratitis following ICRS implantation.

A 40-year-old healthy woman presented 3 months after bilateral 160° Ferrara rings insertion for keratoconus. She complained of worsening pain in her left eye over the past 24 h. Best corrected visual acuity (BCVA) was 1/60 on presentation. Slit lamp examination revealed deep infiltrates around the superior ring segment, microcystic corneal oedema, diffuse punctuate epitheliopathy and anterior chamber inflammation. (figure 1A) There was no hypopyon. The fellow eye revealed ICRS segments with no other pathology. Intraocular pressure was 38 mmHg in the left eye and 18 mmHg in the right …