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Corneal Allogenic Intrastromal Ring Segment (CAIRS) Keratoplasty for Keratoconus

What is keratoconus?

The cornea is the clear structure at the very front of your eye. It is in front of the iris (coloured part of the eye) and it focuses the light entering your eye. The cornea normally has an even, symmetrical shape, like half a soccer ball.

When someone develops keratoconus, the cornea becomes distorted and irregular in shape. This causes the vision to become blurred because the light isn’t focussed accurately in the eye. Keratoconus is an uncommon condition affecting about 1 in 250 people. Keratoconus usually affects both eyes but one eye may be much more affected than the other.

What is CAIRS Keratoplasty?

Corneal Allogenic Ring Segment Keratoplasty, or CAIRS Keratoplasty, is a type of corneal transplant where tiny implants made of donated cornea that are placed into your cornea to treat keratoconus or other conditions causing abnormal corneal shape. They work by reshaping the cornea, flattening its curvature, and redistributing the corneal tissue across the surface of the eye. This helps to improve vision by reducing the irregular eye shape caused by keratoconus.

How is the procedure performed?

The procedure is typically performed under local anesthesia with sedation meaning you can return home the same day. During the surgery:

1. Your eye will be numbed with local anesthesia to ensure you don’t feel any discomfort

2. A laser will be used to cut some ‘channels’ into your cornea where the segments will be inserted

3. The CAIRS will be carefully inserted into the corneal tissue

4. The incision is usually be left to heal on its own but sometimes tiny sutures are required

The entire procedure usually takes around 30 minutes to an hour.

Benefits of CAIRS Keratoplasty

Improved vision by reducing the irregular shape of the cornea.

Can delay or eliminate the need for more invasive procedures like corneal transplantation. Minimal downtime and rapid recovery compared to other surgical options. Allows subsequent procedures if required to further reduce the need for contact lenses or strong glasses.

Risks and Considerations

CAIRS Keratoplasty is a relatively new type of corneal transplant procedure but fortunately the risks are less than similar surgical procedures and much less than traditional corneal transplantation. Like any surgical procedure, there are potential risks and complications, including infection, glare or halos around lights, overcorrection, undercorrection or loss of vision, need to remove or replace the segments and need for further procedures. Rejection of the donor cornea is very uncommon.

Conclusion

Corneal Allogenic Ring Segment (CAIRS) Keratoplasty offer a promising treatment option for individuals suffering from moderate to severe keratoconus. By reshaping the cornea, CAIRS Keratoplasty can improve vision and enhance the quality of life for patients with this condition.

Corneal Allogenic Intrastromal Ring Segment Keratoplasty is a remarkable surgical innovation that can restore vision and improve your quality of life. Dr Brett Drury is a corneal specialist who performs all types of corneal transplants at Outlook Eye Specialists.

Frequently Asked Questions

CAIRS stands for Corneal Allogenic Intrastromal Ring Segments. It is an advanced corneal procedure where tiny implants made from donated human corneal tissue are placed within the corneal stroma to reshape the cornea and improve vision in patients with keratoconus. Unlike synthetic ring implants, CAIRS uses natural tissue that integrates with the host cornea over time.
Traditional synthetic ring segments (such as Intacs or Ferrara rings) are made from plastic and remain as a permanent foreign body in the cornea. CAIRS uses donated human corneal tissue, which is biocompatible, integrates naturally, and does not carry the long-term risks associated with synthetic implants such as extrusion or corneal melting.
CAIRS is suitable for keratoconus patients who have adequate corneal thickness, are experiencing contact lens intolerance or reduced best-corrected vision, and have a corneal shape that is amenable to improvement with ring segments. Your ophthalmologist will assess your corneal topography, OCT, and overall eye health to determine suitability.
CAIRS improves best-corrected and unaided visual acuity in most keratoconus patients by regularising the corneal shape. The degree of improvement varies depending on the severity and pattern of the keratoconus. The goal is to improve optical regularity, reduce contact lens dependence, and potentially defer or avoid the need for corneal transplantation.
Yes. CAIRS is often performed in conjunction with corneal collagen cross linking, either as a combined same-day procedure or as a staged treatment. Cross linking stabilises the cornea and halts progression, while CAIRS reshapes it and improves vision. Your ophthalmologist will recommend the most appropriate approach for your individual case.
A femtosecond laser or mechanical keratome creates a precise tunnel within the corneal stroma at a predetermined depth and location. The donated corneal ring segment is then inserted into the tunnel. The procedure is performed under local or general anaesthetic as a day surgery and takes approximately 30–45 minutes.
Antibiotic and anti-inflammatory drops are prescribed for 4–6 weeks. Vision fluctuates during the healing period and gradually stabilises over 3–6 months. Most patients can return to desk-based work within 1 week. Contact lens wear should be deferred until cleared by your ophthalmologist.
The CAIRS implants can in principle be removed or exchanged if the visual outcome is not satisfactory or complications arise, though this is rarely required. Unlike synthetic ring segments, the biointegration of the corneal tissue over time may make removal progressively more complex as the healing process matures.
CAIRS can significantly delay or in some cases defer the need for corneal transplantation in keratoconus patients. It is most effective in moderate keratoconus cases. Patients with very advanced disease or very thin corneas may ultimately still require a transplant, but CAIRS and cross linking can extend the period of stable, useful vision considerably.
CAIRS keratoplasty attracts a Medicare rebate when performed by a specialist ophthalmologist. Hospital and anaesthetic fees apply as it is performed in a day surgery facility. Our team will provide a detailed cost estimate at your consultation.