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.