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In this report, we investigated the association between the intraocular pressure (IOP) values by two different measurement methods and the corneal biomechanical properties in a patient with keratoconus and secondary glaucoma due to pseudoexfoliation syndrome who developed a marked elevation of intraocular pressure in the right eye.IOP was measured over a period of 3 days with Goldmann applanation tonometry (GAT) and dynamic contour tonometry (Pascal tonometry, DCT). Corneal hysteresis (CH) and corneal resistance factor (CRF) were estimated with the aid of an ocular response analyzer (ORA).CH and CRF were significantly reduced in the right eye compared to the left eye throughout the period of observation (paired t-test, p 0.001). The difference between both methods of IOP measurement in the right eye was statistically significant for IOP 30 mmHg by GAT (Wilcoxon test, p = 0.004). For IOP values 30 mmHg by GAT, there was no statistically significant difference between DCT and GAT (Wilcoxon test, p = 0.0625).This observation supports the clinical hypothesis that a significant decrease in CH translates to a decreased correlation of CH and IOP recordings by GAT and, furthermore, suggests that after a critical point of CH reduction, the impact of CH on GAT may be comparable to that on DCT.In diesem Bericht untersuchten wir den Zusammenhang zwischen den Werten des Augeninnendrucks (IOD) durch 2 verschiedene Messmethoden und den biomechanischen Eigenschaften der Hornhaut bei einem Patienten mit Keratokonus und Sekundärglaukom aufgrund des Pseudoexfoliationssyndroms, der eine deutliche Erhöhung des Augeninnendrucks im rechten Auge entwickelte.Der IOD wurde über einen Zeitraum von 3 Tagen mit der Goldmann-Applanationstonometrie (GAT) und der Pascal-Tonometrie (DCT) gemessen. Die Hornhauthysterese (CH) und der korneale Widerstandsfaktor (CRF) wurden mithilfe des Ocular Response Analyzer (ORA) geschätzt.CH und CRF waren im rechten Auge im Vergleich zum linken Auge während der gesamten Beobachtungszeit signifikant reduziert (Paired t-Test, p 0,001). Der Unterschied zwischen beiden Methoden der IOD-Messung am rechten Auge war für den IOD 30 mmHg mittels GAT statistisch signifikant (Wilcoxon-Test, p = 0,004). Für IOD-Werte 30 mmHg nach GAT gab es keinen statistisch signifikanten Unterschied zwischen DCT und GAT (Wilcoxon-Test, p = 0,0625).

Intracorneal ring segment (ICRS) implantation represents a modern, minimally invasive, surgical option for visual improvement in patients with keratoconus. ICRS modify the corneal geometry in a manner that enhances its refractive properties and thereby, they improve visual acuity. It is well-documented that implantation of ICRS decreases the keratometric readings, spherical equivalent and cylinder, reduces high-order aberrations and improves uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCDVA) in patients with keratoconus. Success rate after ICRS implantation is high, depending on appropriate patient selection and adherence to suitable implantation nomograms, and most important, the overall complication rate is very low. This review is summarizing current indications/contra-indications for ICRS implantation, implantation techniques, clinical outcomes and potential complications, shedding light on myths and realities related to this innovative surgical option.