At the ESCRS Winter Meeting 2025, Ocular Surgery News interviewed Prof. Farhad Hafezi about Extracorporeal Optimization of Corneal Allogenic Intrastromal Ring Segments (ECO-CAIRS), a technique designed to pre-treat allogenic corneal implants with ultra high-fluence corneal cross-linking (CXL) before implantation.
Corneal allogenic intrastromal ring segments (CAIRS) have gained interest as a biological alternative to synthetic intracorneal ring segments (ICRS) for treating keratoconus and other forms of corneal ectasia. While CAIRS offer better biocompatibility than synthetic implants, their integration and long-term stability within the cornea have remained challenges. ECO-CAIRS addresses these limitations by enhancing the biomechanical properties of the allogenic segments prior to implantation.
How Does ECO-CAIRS Work?
ECO-CAIRS modifies the structure of the donor corneal tissue ring segments through ultra high-fluence CXL before implantation. This pre-treatment process involves:
- Soaking the allogenic corneal segments in riboflavin (vitamin B2) to ensure adequate saturation of the tissue.
- Exposing the segments to ultra high-fluence UV-A light to induce collagen cross-linking within the donor tissue.
- Achieving biomechanical stiffening of the implant while maintaining its transparency and shape.
By stiffening the segments before implantation, ECO-CAIRS offers several potential benefits:
- Greater mechanical stability of the implanted segment, reducing post-surgical deformation.
- More predictable corneal reshaping, which improves the long-term refractive effect.
- Improved integration with the recipient cornea, potentially reducing the risk of segment migration or extrusion.
Clinical Implications and Future Directions
During his interview with Ocular Surgery News, Prof. Hafezi highlighted how ECO-CAIRS could improve customizability and precision in keratoconus surgery. By modifying the biomechanical properties of the implant before surgery, the procedure minimizes unpredictability and may help achieve more reproducible outcomes compared to standard CAIRS implantation.
The technique represents a step forward in the use of biological implants for corneal stabilization. While current studies are focused on ex vivo optimization, future research will assess long-term clinical outcomes in patients undergoing ECO-CAIRS-enhanced CAIRS implantation.
The full Ocular Surgery News article on ECO-CAIRS can be accessed here.
