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What exactly is CAIRS? The natural solution

Phake Linsen (ICL) in Zürich

In brief

What is CAIRS?

CAIRS are ring segments made from processed donor corneal tissue that are inserted into a laser-created tunnel in the cornea and flatten a keratoconus bulge. At EyeLaser Zürich, Dr. Victor Derhartunian implants CAIRS with the SCHWIND ATOS femtosecond laser, usually together with corneal crosslinking (CXL). CAIRS costs CHF 4’500 per eye in Zurich.

CAIRS at a glance — EyeLaser Zürich
Material Donor corneal tissue without living cells (KeraNatural™), from a certified cornea bank
Suitable for moderate to advanced keratoconus when glasses and contact lenses are no longer sufficient
Not suitable for dense central scars, a cornea that is too thin, acute inflammation
Procedure outpatient, anaesthesia with drops; tunnel created with the femtosecond laser, without a blade
Combination usually with crosslinking, possibly laser or ICL later
Unable to work usually 3 to 5 days (office work)
Surgeon Dr. Victor Derhartunian personally
Costs CHF 4’500 per eye; cost approval in individual cases
Medically reviewed by Dr. med. univ. Victor Derhartunian, FEBO, FWCRS on 2 October 2026 · Last updated on 2 October 2026

CAIRS is one stage of keratoconus treatment: first stabilise, then improve vision.

CAIRS or plastic rings: what is the difference?

CAIRS and plastic rings compared
Feature CAIRS Plastic rings (PMMA)
Material Donor corneal tissue without living cells Acrylic glass
Shape cut from the tissue, length and thickness adjustable prefabricated sizes
Result in direct comparison similar improvement in shape and visual acuity; with CAIRS, more eyes gained two or more lines of best-corrected visual acuity (60 % versus 31.6 %, 34 eyes each; Asfar et al. 2024)
Known problems still little long-term data over many years extrusion, melting and deposits have been described

The figures come from published studies and are not our own data.

Dr. Victor Derhartunian

Dr. Derhartunian on CAIRS:

«With CAIRS, we can flatten a severely deformed cornea without placing plastic in the eye. We cut the segments to match the shape of the cornea. Long-term data over many years is still lacking; that is why we carry out regular check-ups.»

The blade-free and safe treatment process

Step 1: Precise tunnel creation

Using the femtosecond laser, we create an exact tunnel—completely blade-free and computer-controlled.

Step 2: Gentle implantation

The biological segment is gently placed into the prepared pocket.

Step 3: Immediate stabilization

The segment strengthens the cornea immediately from within and begins to integrate into the tissue.

What do studies show about CAIRS, and what are the risks?

Ein Leben ohne Brille – Erfolgsgeschichten aus Zürich

In the first study of CAIRS with 24 eyes, vision without glasses improved by an average of 2.8 lines and with glasses by 1.3 lines; during the follow-up period of 6 to 18 months, no eye progressed, and there were no complications caused by the segments (Jacob et al. 2018). All eyes also received crosslinking. The studies are small and short; long-term data over many years is lacking. As with any procedure on the cornea, infection, inflammation and displacement of the segments are possible; there is no reliable figure yet for how often this happens.

How much does CAIRS cost in Zurich, and does health insurance pay?

Alterssichtigkeit behandeln in Zürich

At EyeLaser Zürich, CAIRS costs CHF 4’500 per eye, including the follow-up examinations during the first three months. The pre-examination (CHF 300) is credited; crosslinking is billed separately, and for progressive keratoconus it is covered by basic health insurance. You receive medication on prescription.

Whether your health insurance contributes to CAIRS is clarified in advance on a case-by-case basis with a cost approval. All prices: Costs for keratoconus.

The traffic-light system: Are you an ideal candidate for CAIRS?

Augenlasern in Zürich

🟢 Green light:

  • Patients with moderate to advanced keratoconus.
  • Clear intolerance or insufficient vision correction with rigid gas-permeable contact lenses.
  • The desire to avoid a corneal transplant.
  • No pronounced scarring in the center of the cornea.
Augenlasern in Zürich – Sicher, modern & persönlich

🟡 Yellow light:

  • Patients with early central opacities or a very thin cornea.
  • Cases where a combination with other procedures (e.g., cross-linking) must be planned from the outset.

🔴 Red light:

  • Patients with large, dense scars in the center of the cornea.
  • A cornea that is too thin to provide a safe space even for CAIRS.
  • Acute inflammation or infection of the eye.

Is CAIRS an option for me?

The corneal tomography shows this. Make an appointment for an examination at Strehlgasse 33 in Zurich; bring previous measurements and contact lens values with you. You can find other ways of improving vision under Improving vision with keratoconus.

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FAQ: Frequently asked questions about CAIRS in Switzerland

What is the main purpose of CAIRS?

The main goal of CAIRS is the mechanical strengthening and reshaping of a severely bulging cornea. It helps to normalise the eye’s “architecture” again, which improves visual quality and can delay or avoid a corneal transplant.

Where does the donor tissue come from, and is it safe?

The tissue comes from official, certified cornea banks and is subject to the strictest controls. It is processed so that it no longer contains any living cells (acellular); rejection is therefore very unlikely.

Can my body reject the CAIRS implant?

Rejection is very unlikely with CAIRS because the donor tissue no longer contains any living cells. No rejection has been reported in the studies to date (Jacob et al. 2018); however, these studies are small and only cover a few years. At EyeLaser Zürich, we therefore check the segments regularly.

Does CAIRS implantation replace crosslinking?

No, the procedures complement each other perfectly. CAIRS provide mechanical support and reshaping, while crosslinking increases the biochemical stability of the entire cornea. CAIRS are often implanted first and crosslinking is performed in a second step, sometimes even in combination with a laser.

Will CAIRS improve my vision immediately?

CAIRS improve the corneal shape immediately, leading to a rapid improvement in visual quality. However, full integration of the tissue and final stabilisation of vision may take several months.

Is CAIRS implantation painful?

No. The procedure is performed with anaesthetic eye drops and is painless. In the first few days afterwards, you may experience a mild foreign-body sensation or pressure, but no severe pain.

How long will I be unable to work after the procedure?

Most patients can return to office work after 3–5 days. You should avoid physically strenuous or dirty work for about two weeks.

How much does CAIRS treatment cost in Switzerland?

At EyeLaser Zürich, CAIRS costs CHF 4’500 per eye, including the follow-up examinations during the first three months. The pre-examination (CHF 300) is credited if you go ahead with treatment. Additional crosslinking is billed separately, and for progressive keratoconus it is covered by basic health insurance. You receive medication and eye drops on prescription from the pharmacy.

Will my health insurance cover the costs of CAIRS?

We clarify this on a case-by-case basis: EyeLaser Zürich obtains a cost approval from your health insurer before the procedure. As a self-payer, CAIRS costs CHF 4’500 per eye. Additional crosslinking for progressive keratoconus, on the other hand, is a mandatory benefit of basic health insurance.

What is the difference between CAIRS and Intacs/Kerarings?

The difference is the material: CAIRS are made of donor corneal tissue, Intacs and Kerarings of plastic (PMMA). In a comparative study with 34 eyes in each group, the results were similar; with CAIRS, more eyes gained two or more lines of visual acuity with glasses (60 % versus 31.6 %; Asfar et al. 2024). EyeLaser Zürich uses CAIRS. Plastic rings have been observed for longer; for CAIRS, data over many years is still lacking.

How long do the CAIRS segments last?

CAIRS are intended to remain in the cornea permanently. However, the longest published observations only cover a few years, not decades. At EyeLaser Zürich, we check the cornea regularly after CAIRS; if necessary, the segments can be removed surgically.

Can the segments be removed again if necessary?

Although they are designed to remain permanently, the segments can be surgically removed if needed.

I do not live directly in Zurich. How involved is the treatment?

We regularly care for patients from all over Switzerland – from Geneva to Bern and down to Ticino. Since CAIRS implantation is an outpatient procedure, you generally only need to be in Zurich for the treatment day and the important first follow-up examination. Further check-ups can often be coordinated in consultation with your local ophthalmologist.

Is there an age limit for CAIRS?

There is no strict age limit. What matters is the condition of the cornea and the overall health of the eye. The procedure is used in adults of all ages when indicated.

What happens if I still need glasses after CAIRS?

That is normal. CAIRS optimise the corneal shape, but some residual refractive error may remain. This can often be corrected very well with much weaker, simpler glasses. In some cases, an ICL lens can also be implanted for the final correction.

Sources
  1. Jacob S, Patel SR, Agarwal A et al. Corneal Allogenic Intrastromal Ring Segments (CAIRS) Combined With Corneal Cross-linking for Keratoconus. J Refract Surg 2018;34:296–303. PubMed 29738584
  2. Asfar KE, Bteich Y, Mrad AA et al. Corneal Allogenic Intrastromal Ring Segments (CAIRS) Versus Synthetic Segments: A Single Segment Comparative Analysis Using Propensity Score Matching. J Refract Surg 2024;40:e863–e876. PubMed 39530978
  3. Gomes JA, Tan D, Rapuano CJ et al. Global consensus on keratoconus and ectatic diseases. Cornea 2015;34:359–369. PubMed 25738235