The Evolution of CAIRS
In 2016, Dr. Soosan Jacob from India developed Corneal Allogenic Intrastromal Ring Segments (CAIRS). This method utilizes segments created from human donor cornea tissue, aiming to reduce the complications associated with PMMA ring segments. The creation of the tunnel, however, was still performed manually, which can be challenging in very thin keratoconus corneas.
The Evolution of CAIRS
In 2022, Professor Shady Awwad from Lebanon added the precision of the femtosecond laser to the CAIRS technique by incorporating advanced femtosecond laser technology. With this approach, he precisely prepared ring segments from donor human cornea tissue and created a carefully targeted tunnel in the patient’s cornea to insert these segments. This enhanced procedure is known as “All Femto-CAIRS.”
The main advantage of using a femtosecond laser is its ability to precisely customize allogenic ring segments and place them within the cornea of a keratoconus patient in an ideal way. This laser technology enables accurate placement of tunnels in the deeper layers of the cornea. Additionally, because the ring segment is made from human cornea tissue, the risk of breakthrough is eliminated.
ELZA members were implicated in the first publication on the topic (see below).
The Evolution of CAIRS
When we started performing Femto-CAIRS in early 2023, the following questions emerged. After all, we are clinical scientists, always trying to improve our surgical methods:
The answer to all is corneal cross-linking: CXL will stiffen the cornea, sterilize it and transitorily reduce the volume inserted.
The twist that nobody thought of: we do not use the typical total energy of the standard CXL, we go way higher. In the end, we do this irradiation outside the body, where no surrounding tissue can be harmed.
Video 5 seconds of just the ring segments and how they are cross-linked.
No. In the contrary: the implanted corneal ring segment adds additional tissue to your cornea.
Candidates for CAIRS typically have corneal steepness between 50 and 70 diopters and a minimum stromal thickness of 300 micrometers. The expected outcome is a flattening of the cornea by five to more than ten diopters. The procedure also allows for the possibility of further corneal improvements through additional treatments, such as ELZA-PACE (ELZA’s own customized cross-linking) or wavefront-guided transPRK.
Yes. Whether your cornea is progressive or stable is an issue that will be addressed with corneal cross-linking (CXL).
Femto-CAIRS has a different effect, it reshapes the cornea for better vision. Femto-CAIRS can be used in both stable or progressive keratoconus. In the latter, it will be combined with CXL.
All Femto-CAIRS represents an approach in corneal treatment that combines the use of human corneal tissue with laser technology, aimed at addressing corneal irregularities with a focus on both safety and customization to each patient’s cornea.
The beauty of All Femto-CAIRS is that it adds additional tissue to the thin keratoconus cornea (additive surgery). In a next step, the cornea and the patient’s vision can be further improved with other treatments, such as ELZA-PACE and/or wavefront-guided PRK.
The price of Femto-CAIRS depends on several factors, including the individual staging of the patient’s disease and whether one or two ring segments are necessary.
Femto-CAIRS is a complex procedure and involves detailed planning of the placement, length, and width of the ring segment, the preparation of the ring segment from a human donor cornea provided by an eye bank, the planning, calculation, positioning and creation of the corneal tunnel in the patient’s cornea, and implantation of the ring segment under intraoperative control of an optical coherence tomographer (OCT)
The total treatment time including calculation of the profile can take up several hours for the surgeon and his team. All these factors and the additional cost of a human cornea provided by an eye bank make the procedure considerably more costly than a ring implantation with a PMMA plastic ring segment.
Femto-CAIRS is typically recommended for patients with advanced keratoconus who are intolerant to contact lenses and are seeking better visual outcomes with glasses. Your doctor will evaluate your condition and determine if you are a suitable candidate for the procedure.
Yes. You should stop wearing contact lenses at least 2 weeks prior to the preoperative assessment to ensure accurate measurements for surgical planning.
Systemic medications rarely affect the cornea, but it’s important to inform your doctor about all medications you are taking.
Femto-CAIRS is performed under local anesthesia. You will be awake during the procedure but will not feel pain in the eye.
It’s normal to experience:
These symptoms typically last 2–3 days. Vision may be blurry initially but should gradually improve over the following weeks.
Most patients can resume normal daily activities, including work or school, within 5 days, depending on their individual healing and the nature of their job.
Full visual recovery may take several weeks, with some fluctuation in vision during this time.
To promote proper healing, avoid the following:
Some patients notice improvement within a few days, but vision may fluctuate. Final visual stabilization can take up to 3 months.
Yes, but only after the eye has healed and your doctor approves.
You may still require glasses or contact lenses for best vision. Your care team will advise you on when and how to resume lens wear.
Yes, follow-up is essential to monitor healing and the position of the ring segment. Typical follow-up schedule includes:
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