Conservative Management of Intrastromal Corneal Ring Segment Extrusion Using Suture-Assisted Repositioning: A Case Series.

Purpose: To describe a conservative surgical technique for managing Intrastromal Corneal Ring Segment (ICRS) extrusion using suture-assisted repositioning and to report clinical outcomes in a small case series. Methods: This retrospective case series of two eyes (two patients) included eyes with keratoconus that developed recurrent ICRS extrusion despite exhaustive conservative management, including bandage contact lens use, topical antibiotic and corticosteroid therapy, and manual repositioning. Suture-assisted repositioning was performed after exclusion of active infection, corneal melting, or stromal perforation. Following manual repositioning of the segment into its original stromal tunnel, interrupted 10-0 nylon sutures (Sharpoint™, Ref A9003N, Ultraglide Spatula needle, 3/8c 6.15mm; Surgical Specialties Corporation) were placed anterior to mid-stromally to mechanically stabilize the overlying corneal tissue. Postoperative management included topical antibiotics, corticosteroids, and prolonged bandage contact lens use. Clinical outcomes, epithelial healing, complications, and ICRS retention were assessed during follow-up. Given the descriptive nature of this case series and the small sample size (n=2), no formal statistical analysis was performed. Follow-up visits were conducted at 1 month, 2-3 months, and then at 5-6 months post-procedure, with additional visits as clinically indicated. Results: Two eyes of two patients were treated using suture-assisted repositioning. Complete and sustained epithelial healing was achieved in both cases, with no recurrence of segment exposure during follow-up. One eye required a single suture, while the other required two sutures due to greater biomechanical instability. Sutures were retained for approximately 5-6 months and removed after long-term epithelial stability was confirmed. Visual acuity and corneal topography remained stable, and the corneal reshaping effect of the ICRS was preserved. No intraoperative or postoperative complications, including infection, stromal melting, or endothelial compromise, were observed. Conclusion: Suture-assisted repositioning of extruding ICRS represents a minimally invasive, tissue-sparing alternative to explantation in carefully selected cases. This technique may allow durable epithelial healing and preservation of corneal biomechanics while avoiding immediate segment removal. Larger studies with longer follow-up are warranted to further evaluate its role in the management of ICRS extrusion.