To report a 25-year-old man who presented with advance keratoconus in the right eye with uncorrected visual acuity (UCVA) of 0.2 and best spectacle-corrected visual acuity (BSCVA) of 0.33 with +0.50 −9.25 × 45°.

Clinical examination and corneal topography revealed grade III keratoconus in the right eye. Intracorneal ring segments (INTACS SK; Addition Technology, Des Plaines, IL) were implanted without surgical complications at 400 µm, with the 450 µm segments implanted superiorly and inferiorly using the femtosecond laser (Intralase®, Advanced Medical Optics, Inc, Abbott Park, IL).

For 3 months postoperatively, BSCVA remained at 0.5 with plano −4.50 × 25°. The patient was complaining of foreign body sensation in the upper part of the eye and glare asking the surgeon to remove the two segments. The superior segment was removed and the lower segment was rotated 30° counter clockwise. Three months later, UCVA was 0.67 and remained stable for 24 months of follow-up.

This report shows that implanting the thicker segment inferiorly provides better visual results.

Levinger E, Levinger S, Hirsh A. Explantation and Rotation of Intracorneal Ring Segments with the Support of Femtosecond Laser: An Asymmetrical Version. Int J Kerat Ect Cor Dis 2013;2(1):40-42.