LAUSR

Keratoconus is a progressive, non-inflammatory corneal ectatic disease characterized by corneal steepening and thinning, generating a high degree of myopia and irregular astigmatism, thereby severely impairing visual acuity [1]. Traditionally, keratoconus has been managed in first-line treatment with rigid contact lenses, which improved visual acuity in cases of moderate and advanced severity. Corneal transplantation remains an option for patients with very advanced keratoconus, who subsequently achieve mean spectacle-corrected visual acuity of 0.6–0.8 and may also need rigid contact lenses [2]. Today, we use sophisticated diagnostic tools which enable early diagnosis of keratoconus, and we are able to perform corneal crosslinking for stabilization of the corneal conus in relatively early stages of the disease. As a consequence, the need for corneal transplantation has decreased significantly [3]. However, an increasing number of patients with keratoconus are identified in a ‘grey zone’, where their contact lens-corrected vision is not great, but it is enough not to consider corneal transplantation. These patients are in need of effective visual rehabilitation, and their expectations are often relatively high. For the above-mentioned patients, a new era has emerged. A plethora of minimally invasive surgical options have been developed, enhanced and introduced into clinical practice over the past few years. These therapeutic approaches include, among others, the implantation of intracorneal ring segments (ICRS), corneal surface ablation combined with corneal collagen cross-linking (CXL), and implantation of toric phakic intraocular lenses, facilitating effective and, most importantly, safe visual rehabilitation in keratoconus. The first review article from Sakellaris et al. focuses on the role of ICRS implantation in visual improvement in keratoconus. ICRS represent an effective and safe option for restoring visual acuity in patients with moderate keratoconus, by regularizing corneal shape and thereby reducing keratometric readings, spherical equivalent and high-order aberrations [4]. The authors describe in detail modern implantation techniques and nomograms, patient selection criteria, clinical outcomes and complications, emphasizing the advantages and Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.9758633.