%0 Journal Article
%T Hypocellular scar formation or aberrant fibrosis induced by an intrastromal corneal ring: a case report
%A Xiaoguang Cao
%A Roxana Ursea
%A Defen Shen
%A Hema L Ramkumar
%A Chi-Chao Chan
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-398
%X A 47-year-old African-American man with a history of keratoconus and failure in using a Rigid Gas Permeable contact lens received an intrastromal corneal ring implant in his left eye. Due to complications, penetrating keratoplasty was performed. The intrastromal corneal ring channels were surrounded by a dense acellular (channel haze) and/or hypocellular (acidophilic densification) collagen scar and slightly edematous keratocytes. Mild macrophage infiltration was found near the inner aspect of the intrastromal corneal rings. Molecular analyses of the microdissected cells surrounding the intrastromal corneal ring channels and central corneal stroma revealed 10 times lower relative expression of IP-10/CXCL10 mRNA and two times higher CCL5 mRNA in the cells surrounding the intrastromal corneal ring, as compared to the central corneal stroma. IP-10/CXCL10 is a fibrotic and angiostatic chemokine produced by macrophages, endothelial cells and fibroblasts.An intrastromal corneal ring implant can induce hypocellular scar formation and mild inflammation, which may result from aberrant release of fibrosis-related chemokines.Intrastromal corneal ring segments (Intacs, KeraVision, Inc., Fremont, CA, USA), which have been approved for the treatment of myopia and astigmatism associated with keratoconus, are two tiny half rings made of polymethyl methacrylate [1]. Compared with penetrating keratoplasty or laser surgery, Intacs has the advantage of reshaping the abnormal cornea without removing tissue or injuring the central cornea, which is most critical for clear vision. Studies have shown that Intacs could be easily removed, with reversal of visual, refractive, and topographic changes.After implantation of Intacs, an extracellular intrastromal material may be found in the lamellar channel surrounding the segments [2]. This material might spontaneously dissolve after removal of the Intacs segments. Histopathology of corneas implanted with Intacs has been reported, and this materi
%U http://www.jmedicalcasereports.com/content/5/1/398