CAIRS for Keratoconus

By Dr. Adel Barbara, MD, FRCOphth — Ophthalmologist, Cornea & Refractive Surgery
Last medically reviewed: September 2026

CAIRS are segments prepared from donor corneal stromal tissue and implanted within the recipient cornea to regularize its shape and improve functional vision in selected keratoconus patients. They are a visual-rehabilitation option; they do not replace progression assessment or cross-linking when stabilization is required.

CAIRS versus synthetic ICRS

Traditional ICRS are made from transparent PMMA. CAIRS use human donor tissue. Both are placed in peripheral intrastromal channels and aim to modify corneal geometry, but their material properties, customization and evidence base differ.

Who may be considered?

Selection considers cone position, corneal thickness and clarity, spectacle-corrected vision, contact-lens tolerance, previous treatment and the patient’s visual goals. No ring procedure is appropriate for every cornea.

Potential benefits and limitations

Studies report improvements in visual, refractive and topographic measures in selected cohorts. Results vary, long-term evidence remains less mature than for established treatments, and glasses or contact lenses may still be needed.

Risks and recovery

Possible problems include infection, inflammation, haze, displacement, absorption or extrusion of tissue, residual irregularity and the need for repositioning, removal or another procedure. Recovery and follow-up depend on the technique and the individual eye.

Clinical and scientific experience

Dr. Adel Barbara introduced CAIRS in Israel in 2022. A 2026 Scientific Reports paper from the clinical group presents preliminary outcomes; Dr. Ramez Barbara is first author and Dr. Adel Barbara is senior and last author. The study is encouraging while appropriately calling for broader and longer follow-up.

Professional sources

• Scientific Reports — CAIRS for keratoconus, 2026
• CAIRS literature review
• Original CAIRS technique report

General information only. Suitability requires individual corneal assessment.