Intrastromal Corneal Ring Segment Implantation in a Patient with the Bowman Layer Inlay Transplantation for Keratoconus

Keratoconus (KC) is a bilateral ectatic corneal disease which results in changes in the corneal architecture and can lead to severe visual impairment. Treatment options depend on the stage of the disease, and they aim either at improving vision or arrest progression. The Bowman layer transplantation (BLT) is a recent surgical option in patients with KC and may postpone corneal transplantation in some patients. We present a case of a 22-year-old patient with a 10-year follow-up history of progressing KC. A first attempt for an intracorneal ring segment (ICRS) implantation when he was 13 years old was unsuccessful due to a superficially implanted segment. At that time, collagen cross-linking was unavailable, and his young age raised concerns about performing a penetrating keratoplasty/lamellar keratoplasty. A BLT was performed with further ICRS implantation with relative disease stability and visual improvement. ICRS implantation in KC patients with BLT has not previously been described in literature and can be an option in selected patients.