As part of the “What's New in Lenticule-Based Surgery?” session at AAO 2025, Rahul S. Tonk, MD, MBA, outlined practical steps for successfully adding to a practice corneal allogenic intrastromal ring segments (CAIRS) and corneal tissue additional keratoplasty (CTAK)—which, collectively he refers to as intrastromal keratoplasty (IK). These steps align with several key logistics: training, corneal crosslinking strategy, surgical planning, tissue sourcing, and operating room setup.

Dr. Tonk, a cornea specialist with Princeton Eye Group in Princeton, New Jersey, and Wills Eye Hospital in Philadelphia, started by stressing the importance of thorough research and hands-on training. Ophthalmologists should make use of the foundational knowledge at their disposal: relevant literature; visits to or lectures by experienced surgeons; and, of course, wet labs—which may be offered by the American Academy of Ophthalmology, the World Cornea Congress, and eye banks.

When planning surgery, physicians must consider whether the patient has previously undergone corneal crosslinking (CXL) before determining next steps, Dr. Tonk said, emphasizing that “CAIRS reshapes the cornea; it does not replace the need for crosslinking to ensure biomechanical stability.” He provided example scenarios based on the patient’s CXL status. Other presurgical considerations include choice of nomogram; whether to use fresh, surgeon-prepared tissue or commercially prepared tissue; essential instruments; and whether to use a femtosecond laser or manual dissection when creating the channel. Dr. Tonk’s postsurgical recommendations include following up with patients to systematically track refractive and topographic outcomes, and using postoperative data to validate and refine your personal nomogram for improved predictability.

“Mastering these logistical steps is the key to successfully integrating IK into your practice,” Dr. Tonk concluded. OM