{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:09:26Z","timestamp":1789063766876,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T00:00:00Z","timestamp":1670976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vision"],"abstract":"<jats:p>Intrastromal corneal ring segments (ICRS) improve corneal topographic symmetry and reduce corneal aberrations through regularization of the corneal surface, thereby functioning as a viable surgical intervention for patients with keratoconus. This study aims to evaluate changes in lower- (LOAs) and higher-order aberrations (HOAs) amongst varying pupil sizes pre- and post- ICRS implantation in keratoconus patients. We specifically investigate the impact of pupil size on total corneal HOAs up to the 6th order. Twenty-one eyes that underwent ICRS implantation were included in this prospective interventional study. LOAs and HOAs measurements at the 6 mm, 4 mm, and 2 mm pupil diameters were collected preoperatively and at 6 months postoperatively using the Zernicke analysis function on a Scheimpflug device. ICRS implantation demonstrated a statistically significant effect in vertical coma with a \u22120.23 reduction (p = 0.015) for a 4 mm pupil size and a \u22121.384 reduction (p &lt; 0.001) for 6 mm, with no significant effect at 2 mm. Horizontal coma, astigmatism 0\u00b0, astigmatism 45\u00b0, trefoil 5th order 30\u00b0, and RMS HOA demonstrated significant reductions at 4 mm or 6 mm pupil sizes but not at 2 mm. Our analysis demonstrates a favorable effect of ICRS implantation on larger pupil sizes, suggesting the importance of pupil size as it correlates with HOAs reduction.<\/jats:p>","DOI":"10.3390\/vision6040076","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T03:01:51Z","timestamp":1671073311000},"page":"76","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Scheimpflug-Derived Corneal Lower and Higher Order Aberrations Post Intrastromal Corneal Ring Segments for Keratoconus"],"prefix":"10.3390","volume":"6","author":[{"given":"Roberta","family":"M. van den Berg","sequence":"first","affiliation":[{"name":"Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA"},{"name":"Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), S\u00e3o Paulo 04023-062, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"B. van den Berg","sequence":"additional","affiliation":[{"name":"Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA"},{"name":"Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), S\u00e3o Paulo 04023-062, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Dodhia","sequence":"additional","affiliation":[{"name":"Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Shahid","sequence":"additional","affiliation":[{"name":"School of Medicine Columbia, University of South Carolina, Columbia, SC 29208, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5341-8353","authenticated-orcid":false,"given":"Alessandro A.","family":"Jammal","sequence":"additional","affiliation":[{"name":"Duke Eye Center, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"de Freitas","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), S\u00e3o Paulo 04023-062, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolinne M.","family":"Rocha","sequence":"additional","affiliation":[{"name":"Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,14]]},"reference":[{"key":"ref_1","first-page":"8","article-title":"The use of intracorneal ring segments in keratoconus","volume":"3","author":"Alio","year":"2016","journal-title":"Eye Vis. 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