Corneal melting after paclitaxel therapy in a case with intrastromal corneal ring segment (ICRS) implantation

Intrastromal corneal ring segments (ICRS) are small, crescent shaped plastic rings placed in the deep, peripheral corneal stroma to flatten the cornea. Corneal melting is a rare complication of ICRS implantation, with no long term effects reported. Although ocular toxicities are associated with paclitaxel (PTX), corneal melting from PTX therapy remains rare. Here we report a case of corneal melting in a patient who had ICRS implanted 20 years ago following recent PTX therapy for breast cancer. A 35 year old female patient presented with eye pain, photophobia, and blurry vision in her left eye, following a history of ICRS implantation 20 years ago. She was diagnosed with breast cancer 6 months ago and was undergoing PTX chemotherapy therapy. Ocular examination revealed bilateral meibomian gland dysfunction (MGD) and corneal melting in the left eye at the site of the corneal ring. Treatment initially included only eye drops mainly to promote epithelial repair and control inflammation. After 2 weeks, the corneal melting showed signs of healing; however, the patient continued complaining about eye pain and discomfort. Subsequently, amniotic membrane transplantation (AMT) and corneal contact lenses were initiated, leading to significant improvement after 2 months of treatment.