Descemet detachment after femtosecond-laser- assisted placement of intrastromal ring segments in pellucid marginal degeneration Mehdi Ghajarnia, MD, Majid Moshirfar, MD, Mark D. Mifflin, MD We report the case of a 46-year-old man with pellucid marginal degeneration who had uneventful placement of Intacs intrastromal corneal ring segments (Addition Technology) in the left eye be- cause of poor best spectacle-corrected visual acuity and contact lens intolerance. The IntraLase femtosecond laser (IntraLase Corp.) was used to create the channels for the 2 ring segments. Ini- tially, there was subjective visual improvement and the Intacs segments were well positioned. One week after surgery, corneal edema secondary to a large inferior Descemet membrane detachment was seen. The Intacs segments were removed, and an air bubble was placed in the anterior chamber. The Descemet detachment did not resolve, and penetrating keratoplasty was eventually performed. J Cataract Refract Surg 2008; 34:2174–2176 Q 2008 ASCRS and ESCRS Intacs intrastromal corneal rings (ICRs) (Addition Technology) were designed to correct low myopia but have increasingly been used to treat ectatic dis- orders such as keratoconus, 1–3 pellucid marginal de- generation (PMD), 4–6 and ectasia after laser in situ keratomileusis. 7 Long-term follow-up of keratoconic eyes after ICR implantation have demonstrated im- proved best spectacle-corrected visual acuity (BSCVA) and/or improved contact lens tolerance. 1,2,8 Previous studies have demonstrated relatively greater safety and reversibility of ICR placement, especially com- pared with the alternative of penetrating keratoplasty. 3 Complications of ICR implantation include segment movement or extrusion, 2,8,9,10 perforation into the anterior chamber, 10 bacterial keratitis, 8,11,12 channel opacification with haze or deposits, 9,10,13 epithelial plugs, 9 nonvisually significant superficial neovascula- rization, 2 and chronic pain. 14 To our knowledge, there have been no reports of Descemet detachment follow- ing ICR implantation. CASE REPORT A 46-year-old man with PMD, poor visual acuity, and rigid contact lens intolerance, who coincidentally was being treated for dry eyes, consented to have Intacs segments placed in his left eye to improve the BSCVA. Preoperatively, the visual acuity was 20/60 in the right eye and 20/80 À2 in the left eye with spectacles. The manifest refraction was À12.50 C 14.50 Â 180 in the right and not improved over the spectacle correction of –9.75 C 6.50 Â 7 in the left eye. Keratometry readings in the right eye using the Atlas Hum- phrey Corneal Tomography System (Zeiss Humphrey Sys- tems) showed the flattest meridian at 38.00 @ 8 degrees and the steepest meridian at 52.00 @ 98 degrees. The pattern in the left eye was irregular, with the flattest meridian at 45.12 @ 56 degrees and the steepest meridian at 50.62 @ 146 degrees. Using Visante optical coherence tomography (OCT), the minimum corneal thickness in the left eye was 398 mm and the maximum thickness was 754 mm at 5.0 to 7.0 mm from the vertex. With Pentacam pachymetry map- ping, the minimum thickness was 448 mm inferiorly at the 7.0 to 8.0 mm optical zone (Figure 1). Using the IntraLase femtosecond laser (IntraLase Corp.), 2 channels were cut at 400 mm, with inner diameters of 6.7 mm and outer diameters of 8.0 mm. Two 0.35 mm segments were inserted, 1 superiorly and 1 inferiorly. There were no compli- cations during the channel cutting or ICR insertion, and the patient was discharged home with a bandage contact lens. On postoperative day 1, the patient reported subjective im- provement of his vision. A limited amount of microcystic edema was noted over the inferior segment from 5 o’clock to 8 o’clock. The position and depth of the segments were good, with no sign of perforation or stromal edema. Several Accepted for publication June 24, 2008. From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. No author has a financial or proprietary interest in any material or method mentioned. Corresponding author: Mehdi Ghajarnia, MD, John A. Moran Eye Center, 65 Medical Drive, Salt Lake City, Utah 84132, USA. E-mail: mehdi.ghajarnia@hsc.utah.edu. Q 2008 ASCRS and ESCRS 0886-3350/08/$dsee front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2008.06.047 2174 CASE REPORT