{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:36:02Z","timestamp":1786628162400,"version":"build-2736575974"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Purpose:<\/jats:title>\n To evaluate the efficacy and safety of combined intrastromal corneal ring segment (ICRS) implantation in different optical zones for advanced keratoconus.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective study analyzed 32 eyes from 30 patients who underwent combined implantation of an ICRS (320\u00b0 arc, 200 \u00b5m) in the 5-mm zone and a high-myopia ICRS (400 \u00b5m) in the 6-mm zone. Pre- and postoperative (6 months) assessments included best-corrected distance visual acuity (BCVA), manifest refraction spherical equivalent (MRSE), keratometry (K), and asphericity (Q-value).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 32 eyes from 30 patients (mean age: 31.1 \u00b1 10.43 years) were analyzed. Significant postoperative improvements were observed in BCVA (\n P<\/jats:italic>\n = 0.002), MRSE (\n P<\/jats:italic>\n < 0.001), K1, K2, mean K (\n P<\/jats:italic>\n < 0.001), maximum K, tomographic astigmatism, and Q-value (\n P<\/jats:italic>\n < 0.001). No intraoperative or postoperative complications were reported.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Combined ICRS and high-myopia ICRS implantation improves visual acuity, reduces refractive error, and enhances corneal topography in advanced keratoconus. Further studies are needed to confirm long-term stability and safety.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2245_25","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T09:00:21Z","timestamp":1785747621000},"page":"S283-S288","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes after implantation of a combination of intrastromal corneal ring segments in different optical zones in advanced keratoconus"],"prefix":"10.4103","volume":"74","author":[{"given":"Jordana S B","family":"Soares","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Universidade Federal de Goi\u00e1s, Goi\u00e2nia-GO, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateus L dos","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cl\u00ednica de Olhos Leit\u00e3o Guerra, Salvador-BA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo T","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Centro de Excelencia em Oftalmologia, Para de Minas- MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna M","family":"Almodin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital de Olhos Pro Vis\u00e3o, Maringa-PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo K","family":"Moscovici","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Oftalmol\u00f3gico Vis\u00e3o Laser, Santos-SP, Brazil"},{"name":"Department of Ophthalmology, Federal University of S\u00e3o Paulo, S\u00e3o Paulo-SP, Brazil"},{"name":"Postgraduate Program in Translational Medicine, Department of Medicine, Federal University of S\u00e3o Paulo, S\u00e3o Paulo-SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Clinica de Olhos Dr Paulo Ferrara, Belo Horizonte-MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro A","family":"Coscarelli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Clinica de Olhos Ennio Coscarelli, Belo Horizonte-MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Clinica de Olhos Dr Paulo Ferrara, Belo Horizonte-MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"R1-20260813","first-page":"17","article-title":"Association between keratoconus, ocular allergy, and sleeping behavior","volume":"84","author":"Santos","year":"2021","journal-title":"Arq Bras Oftalmol"},{"key":"R2-20260813","doi-asserted-by":"crossref","first-page":"3505","DOI":"10.1177\/11206721211020631","article-title":"Corneal densitometry in patients with keratoconus undergoing intrastromal Ferrara ring implantation","volume":"31","author":"Rodrigues","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"R3-20260813","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1080\/02713683.2023.2202365","article-title":"Spectrophotometric analysis of different polymethyl methacrylate filters and their importance in the implantation of corneal rings","volume":"48","author":"Rodrigues","year":"2023","journal-title":"Curr Eye Res"},{"key":"R4-20260813","doi-asserted-by":"crossref","first-page":"3483","DOI":"10.1177\/11206721211000646","article-title":"Evaluation of keratoconus progression and visual improvement after intrastromal corneal ring segments implantation: A retrospective study","volume":"31","author":"Moscovici","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"R5-20260813","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/ICO.0000000000003285","article-title":"Vision-related quality of life in patients with keratoconus with enantiomorphic topography after bilateral intrastromal corneal ring implantation","volume":"43","author":"Rodrigues","year":"2024","journal-title":"Cornea"},{"key":"R6-20260813","first-page":"802","article-title":"Clinical outcomes after implantation of a new intrastromal corneal ring with 140-degree of arc in patients with corneal ectasia","volume":"11","author":"Sandes","year":"2018","journal-title":"Int J Ophthalmol"},{"key":"R7-20260813","article-title":"Therapeutic analysis in patients with keratoconus","author":"Carvalho","year":"2019","journal-title":"Int J Kerat Ect Cor Dis"},{"key":"R8-20260813","doi-asserted-by":"crossref","first-page":"e2022","DOI":"10.5935\/0004-2749.2022-0035","article-title":"Measurement of the visual axis through two different methods: Quantification and differences for measuring chord \u03bc","volume":"87","author":"Rodrigues","year":"2023","journal-title":"Arq Bras Oftalmol"},{"key":"R9-20260813","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","article-title":"Keratoconus","volume":"42","author":"Rabinowitz","year":"1998","journal-title":"Surv Ophthalmol"},{"key":"R10-20260813","doi-asserted-by":"crossref","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","article-title":"Keratoconus: An updated review","volume":"45","author":"Santodomingo-Rubido","year":"2022","journal-title":"Cont Lens Anterior Eye"},{"key":"R11-20260813","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/bjophthalmol-2020-316481","article-title":"Progression of keratoconus in children and adolescents","volume":"107","author":"Meyer","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"R12-20260813","doi-asserted-by":"crossref","first-page":"101792","DOI":"10.1016\/j.clae.2022.101792","article-title":"Progressive keratoconus in patients older than 48 years","volume":"46","author":"Kollros","year":"2023","journal-title":"Cont Lens Anterior Eye"},{"key":"R13-20260813","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1146\/annurev-vision-121219-081723","article-title":"Genetic and environmental risk factors for keratoconus","volume":"6","author":"Lucas","year":"2020","journal-title":"Annu Rev Vis Sci"},{"key":"R14-20260813","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1007\/s00417-021-05081-8","article-title":"Eye rubbing in the aetiology of keratoconus: A systematic review and meta-analysis","volume":"259","author":"Sahebjada","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R15-20260813","doi-asserted-by":"crossref","first-page":"e0278455","DOI":"10.1371\/journal.pone.0278455","article-title":"Biomechanics of keratoconus: Two numerical studies","volume":"18","author":"Falgayrettes","year":"2023","journal-title":"PLoS One"},{"key":"R16-20260813","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 (Lond)"},{"key":"R17-20260813","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000357979","article-title":"Corneal collagen crosslinking: A systematic review","volume":"232","author":"Sorkin","year":"2014","journal-title":"Ophthalmologica"},{"key":"R18-20260813","first-page":"CD011150","article-title":"Intrastromal corneal ring segments for treating keratoconus","volume":"5","author":"Zadnik","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"R19-20260813","first-page":"CD00970","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus","volume":"2014","author":"Keane","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"R20-20260813","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/APO.0000000000000338","article-title":"Lamellar keratoplasty for advanced keratoconus","volume":"9","author":"Patil","year":"2020","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"R21-20260813","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/11206721231201661","article-title":"Results of intrastromal corneal ring implantation in advanced keratoconus with the aim of postponing or avoiding corneal transplantation","volume":"34","author":"Soares","year":"2024","journal-title":"Eur J Ophthalmol"},{"issue":"Suppl 1","key":"R22-20260813","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":"R23-20260813","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.18240\/ijo.2021.09.12","article-title":"Evaluation of a new nomogram for Ferrara ring segment implantation in keratoconus","volume":"14","author":"Fern\u00e1ndez","year":"2021","journal-title":"Int J Ophthalmol"},{"key":"R24-20260813","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.18240\/ijo.2020.12.17","article-title":"Preliminary results of a new intrastromal corneal ring segment as a tissue-saving procedure in photorefractive keratectomy to correct moderate to high myopia","volume":"13","author":"Coscarelli","year":"2020","journal-title":"Int J Ophthalmol"},{"key":"R25-20260813","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/01.ico.0000167883.63266.60","article-title":"Modified intracorneal ring segment implantations (INTACS) for the management of moderate to advanced keratoconus: Efficacy and complications","volume":"25","author":"Kanellopoulos","year":"2006","journal-title":"Cornea"},{"key":"R26-20260813","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","author":"Bautista-Llamas","year":"2019","journal-title":"J Refract Surg"},{"key":"R27-20260813","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3928\/1081597X-20180108-01","article-title":"Predictability of tunnel depth for intrastromal corneal ring segments implantation between manual and femtosecond laser techniques","volume":"34","author":"Monteiro","year":"2018","journal-title":"J Refract Surg"},{"key":"R28-20260813","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1177\/1120672121994731","article-title":"Visual outcomes in advanced keratoconus using different strategies: Scleral lens, intracorneal ring segment and lamellar keratoplasty","volume":"31","author":"Rocha","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"R29-20260813","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/ICO.0000000000001519","article-title":"Additional intrastromal corneal ring segments in keratoconus","volume":"37","author":"Hashemi","year":"2018","journal-title":"Cornea"},{"key":"R30-20260813","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1097\/ICO.0000000000001709","article-title":"Clinical outcomes after implantation of 320\u00b0-arc length intrastromal corneal ring segments in keratoconus","volume":"37","author":"Torquetti","year":"2018","journal-title":"Cornea"},{"key":"R31-20260813","doi-asserted-by":"crossref","first-page":"78","DOI":"10.4103\/tjo.TJO-D-24-00004","article-title":"Outcomes of 320-degree intrastromal corneal ring segment implantation for advanced keratoconus","volume":"14","author":"Chen","year":"2024","journal-title":"Taiwan J Ophthalmol"},{"key":"R32-20260813","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1177\/1120672118818018","article-title":"Outcomes of a 320-degree intrastromal corneal ring segment implantation for keratoconus: Results of a 6-month follow-up","volume":"30","author":"Rocha","year":"2020","journal-title":"Eur J Ophthalmol"},{"key":"R33-20260813","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.jcrs.2015.03.010","article-title":"Reshaping procedures for the surgical management of corneal ectasia","volume":"41","author":"Ziaei","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"R34-20260813","doi-asserted-by":"crossref","first-page":"610","DOI":"10.3928\/1081597X-20170621-02","article-title":"Toric ICL implantation after sequential intracorneal ring segments implantation and corneal cross-linking in keratoconus: 2-year follow-up","volume":"33","author":"Abdelmassih","year":"2017","journal-title":"J Refract Surg"},{"key":"R35-20260813","doi-asserted-by":"crossref","first-page":"104","DOI":"10.3928\/1081597X-20191217-01","article-title":"Three-step treatment of keratoconus and post-LASIK ectasia: Implantation of ICRS, corneal cross-linking, and implantation of toric posterior chamber phakic IOLs","volume":"36","author":"He","year":"2020","journal-title":"J Refract Surg"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2245_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:57:51Z","timestamp":1786625871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2245_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":35,"journal-issue":{"issue":"Suppl 2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_2245_25","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2025-09-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}