Corneal incision contracture: literature review and report of a novel therapeutic strategy using intrastromal corneal ring segments.

PURPOSE: This review summarizes key aspects of corneal incision contracture (CIC), also known as wound burn. CIC is a rare complication of phacoemulsification, which can significantly compromise surgical outcomes, leading to delayed healing, suboptimal functional results, and patient dissatisfaction.

METHODS

A comprehensive literature review was conducted across multiple databases, encompassing full-length studies, case series, and reports. A total of 52 studies were selected, focusing either on the etiopathogenesis and risk factors of CIC or on different treatment strategies.

RESULTS

Although preventing CIC remains challenging, key risk factors include excessive ultrasound energy, the use of high-viscosity ophthalmic viscosurgical devices (OVDs), and narrower, longer incisions, particularly in shallow anterior chambers. Additionally, this review highlights therapeutic approaches for managing both the acute and chronic phases of CIC. A critical analysis of previous reports reveals a lack of consensus on management and limited attention to long-term rehabilitation, contributing to suboptimal visual outcomes in the majority of patients. Finally, we propose a novel treatment for the chronic phase of CIC: the implantation of intracorneal ring segments (ICRS), a technique not previously described. This method was successfully applied in a patient with severe CIC-induced astigmatism (> 23 diopters), achieving a plano spherical equivalent and a final visual acuity (VA) of 0.8 decimal (0.1 logMAR). This outcome surpasses those reported in previous literature.

CONCLUSION

This study highlights the significant challenges associated with CIC and introduces a promising therapeutic strategy using ICRS implantation, potentially improving outcomes for these complex cases.