{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:27:57Z","timestamp":1785414477492,"version":"3.56.0"},"reference-count":63,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007771","name":"Medical University of Silesia","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100007771","id-type":"DOI","asserted-by":"publisher"}]},{"award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"https:\/\/ror.org\/005k7hp45","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Keratoconus is a progressive corneal ectatic disorder leading to irregular astigmatism and visual impairment. INTACS intracorneal ring segments are used to improve corneal shape and visual function; however, postoperative complications may occur. A comprehensive and evidence-based evaluation of visual outcomes and complications after INTACS implantation is therefore warranted. Methods: PubMed, Scopus, and Google Scholar were searched for English-language articles published between January 2015 and December 2025 using the terms INTACS, intracorneal ring segments, keratoconus, and complications, following a systematic literature search conducted in accordance with PRISMA 2020 guidelines. Only studies reporting INTACS-specific outcomes were included. Studies evaluating other intracorneal ring systems were excluded unless INTACS data could be separately extracted. Results: Seventeen studies comprising 544 eyes were included. INTACS implantation was associated with consistent improvements in visual acuity and corneal parameters. However, clinically relevant device-related complications, including segment migration, extrusion, and the need for secondary procedures such as repositioning or explantation, remain an important limitation. These findings indicate that although INTACS is an effective corneal regularization strategy, long-term safety depends on careful patient selection, precise surgical technique, and close postoperative surveillance. Conclusions: INTACS implantation is an effective option for visual rehabilitation in patients with keratoconus; however, its long-term safety is limited by the risk of device-related complications. Careful patient selection, appropriate surgical technique, and structured postoperative follow-up are essential to optimize outcomes and minimize adverse events.<\/jats:p>","DOI":"10.3390\/jcm15114076","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T11:57:44Z","timestamp":1779710264000},"page":"4076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes and Complications After INTACS Implantation in Keratoconus: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1741-7235","authenticated-orcid":false,"given":"Wiktoria","family":"Czuj-Por\u0119bska","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7295-4936","authenticated-orcid":false,"given":"Adam","family":"Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Experimental Ophthalmology Unit, Department of Biophysics, Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6517-5919","authenticated-orcid":false,"given":"Anna","family":"Martyka","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, School of Medicine in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Gospodarczyk","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, School of Medicine in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"Pi\u0142at","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, School of Medicine in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-5790","authenticated-orcid":false,"given":"Edward","family":"Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, School of Medicine in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogumi\u0142","family":"Wowra","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, School of Medicine in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","article-title":"Keratoconus: An updated review","volume":"45","author":"Carracedo","year":"2022","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Deshmukh, R., Ong, Z.Z., Rampat, R., Ali\u00f3 del Barrio, J.L., Barua, A., Ang, M., Mehta, J.S., Said, D.G., Dua, H.S., and Ambr\u00f3sio, R. (2023). Management of keratoconus: An updated review. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1212314"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/ICO.0000000000000408","article-title":"Global consensus on keratoconus and ectatic diseases","volume":"34","author":"Gomes","year":"2015","journal-title":"Cornea"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Son, H.S., Friedrich, M., Jun, A.S., and Soiberman, U.S. (2025). Advancements and innovations in keratoconus management: A review of current practices. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217491"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1002\/ar.24090","article-title":"Keratoconus at a molecular level: A review","volume":"303","author":"Volatier","year":"2020","journal-title":"Anat. Rec."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1038\/s41433-020-1065-z","article-title":"Current perspectives in the management of keratoconus with contact lenses","volume":"34","author":"Lim","year":"2020","journal-title":"Eye"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.joco.2017.11.002","article-title":"Updates on managements for keratoconus","volume":"30","author":"Mohammadpour","year":"2017","journal-title":"J. Curr. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"829","DOI":"10.3928\/1081597X-20160822-01","article-title":"Intracorneal ring segments implantation for corneal ectasia","volume":"32","author":"Giacomin","year":"2016","journal-title":"J. Refract. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/s41598-018-36668-7","article-title":"Long-term outcome of intrastromal corneal ring segments in keratoconus: Five-year follow-up","volume":"9","author":"Kang","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.joco.2016.10.004","article-title":"Effects of single-segment Intacs implantation on visual acuity and corneal topographic indices of keratoconus","volume":"29","author":"Amanzadeh","year":"2017","journal-title":"J. Curr. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1167\/tvst.8.3.38","article-title":"Efficacy of different procedures of intra-corneal ring segment implantation in keratoconus: A systematic review and meta-analysis","volume":"8","author":"Pereira","year":"2019","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Al Zabadi, H., Shehadeh, M., Amro, L., Ghattass, N., and Taha, I. (2023). Vision-related quality of life among patients with keratoconus: A cross-sectional study. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1208911"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4103\/IJO.IJO_1190_23","article-title":"Keratoconus in India: Clinical presentation and demographic distribution based on big data analytics","volume":"72","author":"Das","year":"2024","journal-title":"Indian J. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.optom.2019.11.001","article-title":"A review of corneal imaging methods for the early diagnosis of pre-clinical keratoconus","volume":"13","author":"Masiwa","year":"2020","journal-title":"J. Optom."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"24399","DOI":"10.1038\/s41598-025-09694-5","article-title":"Machine learning-assisted early detection of keratoconus: A comparative analysis of corneal topography and biomechanical data","volume":"15","author":"Syta","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"109062","DOI":"10.1016\/j.exer.2022.109062","article-title":"Pathogenesis of keratoconus: NRF2-antioxidant, extracellular matrix and cellular dysfunctions","volume":"219","author":"Chakravarti","year":"2022","journal-title":"Exp. Eye Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s40662-025-00435-3","article-title":"Early diagnosis of keratoconus using corneal biomechanics and OCT derived technologies","volume":"12","author":"Wang","year":"2025","journal-title":"Eye Vis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/ICO.0000000000002170","article-title":"Measurement of quality of life in keratoconus","volume":"39","author":"Kandel","year":"2020","journal-title":"Cornea"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40662-016-0040-z","article-title":"The use of intracorneal ring segments in keratoconus","volume":"3","year":"2016","journal-title":"Eye Vis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s40662-024-00379-0","article-title":"Criteria for patient selection and indication for intracorneal ring segments in keratoconus","volume":"11","author":"Vega","year":"2024","journal-title":"Eye Vis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ali\u00f3, J.L. (2017). Intracorneal ring segments: Types, indications and outcomes. Keratoconus. Essentials in Ophthalmology, Springer.","DOI":"10.1007\/978-3-319-43881-8"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40123-019-00211-2","article-title":"Intracorneal ring segment implantation in the management of keratoconus: An evidence-based approach","volume":"8","author":"Sakellaris","year":"2019","journal-title":"Ophthalmol. Ther."},{"key":"ref_23","first-page":"25158414251371521","article-title":"Intrastromal corneal ring segments for keratoconus: A comprehensive review of different types","volume":"17","author":"Tlaiss","year":"2025","journal-title":"Ther. Adv. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2249","DOI":"10.2147\/OPTH.S520174","article-title":"Intracorneal ring segments in keratoconus: A narrative literature review","volume":"19","author":"Hayat","year":"2025","journal-title":"Clin. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"916385","DOI":"10.1155\/2015\/916385","article-title":"Intrastromal corneal ring segment implantation (KeraRing 355\u00b0) in patients with central keratoconus: 6-Month follow-up","volume":"2015","author":"Jadidi","year":"2015","journal-title":"J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1007\/s10792-016-0385-2","article-title":"Clinical evaluation of two types of intracorneal ring segments (ICRS) for keratoconus","volume":"37","author":"Osuagwu","year":"2017","journal-title":"Int. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3723","DOI":"10.4103\/IJO.IJO_1988_23","article-title":"Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone","volume":"71","author":"Jacob","year":"2023","journal-title":"Indian. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"740","DOI":"10.3928\/1081597X-20191010-02","article-title":"Complications and explantation reasons in intracorneal ring segments (ICRS) implantation: A systematic review","volume":"35","year":"2019","journal-title":"J. Refract. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hashemian, S.J., and Hadi, Y. (2024). Intracorneal ring segments in corneal ectasia. Keratoconus, CRC Press, Taylor & Francis Group.","DOI":"10.1201\/9781003371601-16"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4447","DOI":"10.2147\/OPTH.S333832","article-title":"One-year outcomes of intracorneal ring\u2013segment insertion assisted by femtosecond laser simultaneously performed with corneal collagen cross-linking for treatment of keratoconus","volume":"15","author":"Rashid","year":"2021","journal-title":"Clin. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1080\/02713683.2018.1540706","article-title":"Analysis of the outcomes of combined cross-linking with intracorneal ring segment implantation for the treatment of pediatric keratoconus","volume":"44","author":"Iqbal","year":"2019","journal-title":"Curr. Eye Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Morales, P., and Dur\u00e1n, J.A. (2025). Advances in intracorneal ring segment (ICRS) implantation for keratoconus: A comprehensive literature review, clinical insights, and future prospects. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134454"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Levy, I., Mukhija, R., and Nanavaty, M.A. (2025). Corneal allogenic intrastromal ring segments: A literature review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041340"},{"key":"ref_34","first-page":"23","article-title":"Implantation of intracorneal ring segments in pediatric patients: Long-term follow-up","volume":"11","author":"Abreu","year":"2018","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/2008-322X.180698","article-title":"Visual, keratometric and corneal biomechanical changes after Intacs SK implantation for moderate to severe keratoconus","volume":"11","author":"Zare","year":"2016","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"74","DOI":"10.4103\/0974-9233.148353","article-title":"Comparison of visual, refractive and topographic keratometry outcomes of Intacs and Intacs SK in mild to moderate keratoconus eyes","volume":"22","year":"2015","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.ajo.2020.07.032","article-title":"Biomicroscopic findings and management of anterior stromal necrosis after long-term implantation of Intacs","volume":"220","author":"Abad","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/APO.0000000000000342","article-title":"Intracorneal ring segments followed by simultaneous topography-guided removal of epithelium and stroma with accelerated collagen cross-linking for keratoconus (I-TRESK\/CXL)","volume":"10","author":"Shetty","year":"2021","journal-title":"Asia Pac. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1159\/000518012","article-title":"Delayed perforation of an intrastromal corneal ring segment into the anterior chamber: A case report and review of the literature","volume":"12","author":"Moshirfar","year":"2021","journal-title":"Case Rep. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/cxo.12810","article-title":"Microbial keratitis following intracorneal ring implantation","volume":"102","author":"Tabatabaei","year":"2019","journal-title":"Clin. Exp. Optom."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/sjopt.sjopt_70_22","article-title":"Long-term outcomes and causes of intrastromal corneal ring segment explantation in a tertiary eye hospital","volume":"36","author":"Maktabi","year":"2022","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"376","DOI":"10.4103\/jovr.jovr_42_17","article-title":"Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus","volume":"13","author":"Hashemian","year":"2018","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4103\/sjopt.sjopt_22_23","article-title":"New technique for enhancing the astigmatic correction of intracorneal ring segments in keratoconus eyes with a central cone","volume":"39","author":"Bteich","year":"2025","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3928\/1081597X-20150521-05","article-title":"Intrastromal corneal ring segment explantation in patients with keratoconus: Causes, technique, and outcomes","volume":"31","author":"Chhadva","year":"2015","journal-title":"J. Refract. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/ICL.0000000000000106","article-title":"Femtosecond-assisted intrastromal corneal single-segment ring implantation in patients with keratoconus: A 12-Month follow-up","volume":"41","author":"Hashemi","year":"2015","journal-title":"Eye Contact Lens"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7850216","DOI":"10.1155\/2019\/7850216","article-title":"One-year efficacy and safety of combined photorefractive keratectomy and accelerated corneal collagen cross-linking after Intacs SK intracorneal ring segment implantation in moderate keratoconus","volume":"2019","author":"Koh","year":"2019","journal-title":"BioMed Res. Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S495","DOI":"10.4103\/IJO.IJO_2944_23","article-title":"Evaluation of dynamic corneal response parameters and the biomechanical E-staging after Intacs\u00ae SK implantation in keratoconus","volume":"72","author":"Flockerzi","year":"2024","journal-title":"Indian J. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"7127534","DOI":"10.1155\/2016\/7127534","article-title":"Polar value analysis of corneal astigmatism in intrastromal corneal ring segment implantation","volume":"2016","author":"Rho","year":"2016","journal-title":"J. Ophthalmol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.jcrs.2019.01.020","article-title":"Corneal crosslinking and intracorneal ring segments for keratoconus: A randomized study of concurrent versus sequential surgery","volume":"45","author":"Hersh","year":"2019","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jcrs.2018.09.021","article-title":"Incidence and associations of intracorneal ring segment explantation","volume":"45","author":"Nguyen","year":"2019","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s40123-017-0105-7","article-title":"Corneal hydrops secondary to intrastromal corneal ring intrusion into the anterior chamber 7 years after implantation: A case report","volume":"6","author":"Moshirfar","year":"2017","journal-title":"Ophthalmol. Ther."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2147\/OPTH.S39963","article-title":"Post intrastromal corneal ring segments insertion complicated by Candida parapsilosis keratitis","volume":"7","author":"Mitchell","year":"2013","journal-title":"Clin. Ophthalmol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5005\/jp-journals-10025-1066","article-title":"Corneal neovascularization and lipid keratopathy after Intacs SK in keratoconus","volume":"2","author":"Barbara","year":"2013","journal-title":"Int. J. Keratoconus Ectatic Corneal Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1007\/s00417-022-05572-2","article-title":"Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus","volume":"260","author":"Hamon","year":"2022","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"317","DOI":"10.4103\/0974-9233.90136","article-title":"Histopathologic findings in two cases with history of intrastromal corneal ring segments insertion","volume":"18","author":"Alkatan","year":"2011","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kapelushnik, N., Werner, L., Levinger, N., Levinger, S., and Barequet, I.S. (2024). Ex vivo histological analysis of corneas with manually implanted intracorneal stromal ring segments. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113350"},{"key":"ref_57","first-page":"593","article-title":"Alteration in epithelium and stroma of post-INTACS cornea: Ultrastructure and 3D transmission electron tomography","volume":"41","author":"Akhtar","year":"2025","journal-title":"Histol. Histopathol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4274\/tjo.galenos.2020.70481","article-title":"Update on contact lens treatment of keratoconus","volume":"50","year":"2020","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.clae.2015.03.016","article-title":"Feasibility of custom-made hydrogel contact lenses in keratoconus with previous implantation of intracorneal ring segments","volume":"38","year":"2015","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.clae.2017.10.013","article-title":"Scleral lens after intracorneal ring segments in patients with keratoconus","volume":"41","author":"Rathi","year":"2018","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_61","first-page":"e77102","article-title":"Long-term effectiveness of scleral lens treatment in the management of keratoconus: A systematic review","volume":"17","author":"Mushtaq","year":"2025","journal-title":"Cureus"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1080\/02713683.2019.1635165","article-title":"Comparison of complicating rate between manual and femtosecond laser-assisted techniques for intrastromal corneal ring segments implantation in keratoconus","volume":"44","author":"Monteiro","year":"2019","journal-title":"Curr. Eye Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T12:21:01Z","timestamp":1779711661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":63,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114076"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114076","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}