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PURPOSE: To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and the relationship with the microscopic findings on the ICRS surface. SETTING: Vissum Corporation–Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This study evaluated ICRS that were explanted in centers in Spain from 2000 to 2008. Clinical data (reasons for explantation, date of implantation/explantation, tunnel creation technique, ICRS type) and scanning electron microscopy findings on the ICRS surface (adherent tissue-like material, cell deposits, protein) were documented. RESULTS: Intrastromal corneal ring segments were explanted from 58 eyes (47 patients). The main cause was extrusion (48.2% of explanted segments), followed by refractive failure (ie, poor refractive outcome) (37.9%), keratitis (6.8%; 3.7% culture positive), and corneal melting and perforation (6.8%). Scanning electron …