Intrastromal Corneal Ring

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What is an intrastromal corneal ring?

An intrastromal corneal ring (ICR) is a ring of plastic that is inserted into an outer layer of your cornea (the clear outer layer on the front of the eye). This ring helps reduce nearsightedness (when you cannot see distant objects clearly).

How does it work?

Nearsightedness occurs when the eyeball is too long or the focusing power of the eye is too strong. Light rays that normally focus on the retina (light-sensitive tissue at the back of the eye) focus in front of it. This causes images to appear blurry.

During surgery, two sections of the ring are placed just outside the center of the cornea. They flatten the cornea. Light rays then focus on or closer to the retina, which improves your vision.

One eye is done at a time.

When is it used?

ICRs are most successful for mild or moderate nearsightedness. They are used when you want a procedure that helps you see better but may be reversed, unlike other surgery for nearsightedness.

How do I prepare for the procedure?

Do not wear any makeup the day of surgery.

The surgery is done in a procedure room or surgical center. You will need to arrange for someone to take you home about an hour after the surgery. Allow for time to rest at home while your eye heals.

What happens during the procedure?

Your ophthalmologist numbs your eye with special eyedrops. Then the doctor makes small cuts in the outer edge of the cornea. Starting at these cuts, the doctor makes tunnels under the outer layer of the cornea to hold the sections of the ring. (The tunnels are made in a layer called the stroma, which is why the ring is called intrastromal.) The doctor inserts both sections of the ring into the tunnels and closes the cuts with one or more stitches.

What happens after the procedure?

Do not rub your eye at any time after the procedure.

You will feel some discomfort, which may last for a day or two. Your provider may put a patch on your eye. He or she will examine your eye the next day.

Your provider may give you medicine for:

• swelling
• pain
• infection
• redness and irritation

Use all your medicines exactly as prescribed. Keep all your appointments for checkups and removing your stitches. If you still need glasses, ask your eye care provider when you should be tested for new lenses. (You cannot wear any type of contact lenses with ICRs in place.)

Your provider may recommend that you wear an eye shield at night to protect against injury or rubbing while you are asleep.

What are the risks of this procedure?

As with any surgery, the results are not guaranteed. Your eyes may be over-corrected, and you may become farsighted.

You may not get enough correction and still need glasses for distance vision. You may find that the best vision you can have is worse than before the procedure.

You may need reading glasses for close vision. After eye surgery some people need to begin using reading glasses sooner than they would have without it. (Most people need reading glasses after about age 40 because of changes in their eyes as they get older.)

You may also have:

• pain, burning, or itching in your eye
• infection
• an increase in astigmatism (uneven cornea, which causes blurry vision)
• changes in your vision
• double vision
• halos or glare in your field of vision
• reduced night vision

What are the benefits of this procedure?

You may not need glasses for distance vision. If you still need glasses, you may be able to have thinner lenses. Most people (97% in some studies) have vision of 20/40 or better without glasses after the procedure.

Your surgeon can remove corneal rings if they cause problems, or replace them with rings of a different size if needed. After the rings are removed, you can wear glasses or contacts.

When should I call my eye care provider?

Call your provider right away if you have any pain for more than a week after your surgery.

Also, call your provider right away at any time if you have:

• a loss of vision
• a lot of drainage from your eye
• severe or worsening pain

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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