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What are Corneal Rings?

Intracorneal rings are well tolerated, with a very low risk of rejection by the organism. Intracorneal ring segment surgery is a completely reversible procedure.

And Intracorneal Rings?

The technique known as intracorneal ring implantation with the use of different rings such as kerarings, ferrara rings or intacs was developed by brazilian ophthalmologists and investigators over two decades of research on how to stabilize the corneal deformity produced by keratoconus.

Today, this technique is performed worldwide at the most prestigious and experienced ophthalmology centers with experience in keratoconus.


Intrastromal rings are semi-circular segments, of specific varying thicknesses, with a 5 mm optical zone, made of Perspex CQ Acrylic. This type of material has been in use in ophthalmology over the past 30 years in intraocular lenses used in cataract surgery.



Intracorneal rings are well tolerated, with a very low risk of rejection by the organism. Intracorneal ring segment surgery is a completely reversible procedure. If necessary, ring segments can be removed at any time, and the cornea will return to its original shape.

How do intrastromal rings work?

Corneal rings work through several mechanisms. They are placed at a depth of 80% of the corneal thickness at 6 to 8 mm from the pupil center.

By adding "tissue" to the corneal periphery, flattening of the central cornea is achieved. This helps reduce the amount of myopia commonly encountered in patients with keratoconus.

The size and thickness of the rings are chosen according to the corneal deformation caused by the keratoconus. Usually longer and thicker rings are needed for more severe cases.

Ring placement can sometimes help get rid of striae in the cornea in more advanced cases, helping to significantly improve vision. It is a safe procedure usually performed in 15 minutes.

How will I know if I am a candidate for surgery?

In the later stages of keratoconus, several clinical signs are visible on examination. However, numerous information is not available on simple examination, such as keratoconus size, staging, corneal thinning, among other information necessary to determine if a patient is a candidate for corneal ring surgery. Elevation corneal topography should be performed in any patient with keratoconus.

Table 1

The prescription size was reduced in 70% and sustained over 60 months follow-up. This improvement was found to be directly related to the size of keratoconus. Grade 1 and 2 keratoconus had greater improvement than Grade 3 keratoconus.

Table 2

The prescription size was reduced in 70% and sustained over 60 months follow-up. This improvement was found to be directly related to the size of keratoconus. Grade 1 and 2 keratoconus had greater improvement than Grade 3 keratoconus.

Table 3

As keratoconus progression occurs, the cornea progressively deforms. With the use of corneal rings, we were able to stop cornea deformity and reduce curvature to more normal values with stability of 60 months of follow-up.

When are Intracorneal Rings Indicated?


  • Keratoconus (grade 1, 2, and 3)
  • Irregular Astigmatism
  • Refractive Surgery Induced Irregular Astigmatism
  • Post-Queratoplasty Induced Irregular Astigmatism
  • Hard Contact Lens Intolerance

How is the Surgical Procedure Performed?

The surgery is performed under topical anesthesia in a surgical suite. After preparing the patient (cleaning your face with an antiseptic and eye drops), the surgical nurses will guide you into the surgical suite where the doctor will perform the surgery. Your face will be covered with a sterile surgical drape to avoid contamination. Utilizing the Ziemer FEMTO LDV Z8 laser, perfectly centered stromal pockets are created outside the pupil diameter so that the rings to be implanted, according to our personalized nomograms, the result of 15 years of experience in ring surgery at Clinica de Ojos de Tijuana, can be placed. The surgical procedure lasts 10 minutes and is painless. Antibiotic and Anti-inflammatory eye drops will be instilled at the end of surgery.

You will be able to return to your normal activities within three (3) days.

What experience do we have in keratoconus and intraocorneal ring surgery?

Clínica de Ojos de Tijuana was first ophthalmology center in Mexico and one of the first Worldwide to use intracorneal ring 10 years ago for keratoconus treatment.

Today, we are a referral center for keratoconus patients in Mexico and the southwest United States for the treatment of this disease.

We have performed this surgery in thousands of keratoconus patients with very good results.

What are the objectives with intracorneal ring surgery?

The main goal of intracorneal ring surgery is stop or slow progression of keratoconus, delaying or avoiding the need for corneal transplant surgery. A secondary goal of surgery is to improve vision. Patients will notice a decrease in prescription size and an improvement in visual acuity.

The advantage of corneal ring surgery is that it allows a fast visual recovery without a prolonged recovery time as is needed with a corneal transplant. Rehabilitation time usually takes approximately 3 months.



Nonetheless this surgery does not preclude the possibility of a future transplant surgery. If the intrastromal rings are not tolerated, they can be removed and the cornea will return to its original shape.

What risks or complications are associated during or after surgery?

The risk of complications associated with this type of surgery is minimal. Intolerance to the intrastromal ring has been observed in less than 1% of patients. The risk of infection is reported in the medical literature to be 0.0001%.

Key Points Summary
  • Intacs Inserts: Semi-circular rings implanted in the cornea to flatten keratoconus bulges and improve vision.
  • Minimally Invasive: The procedure is minimally invasive and reversible, offering an alternative to corneal transplants.
  • Improves Contact Lens Fit: Can make contact lens wear more comfortable and effective for keratoconus patients.
  • Quick Recovery: Most patients return to normal activities within a few days.
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