ArticleOphthalmology and therapy2026
Tomographic and Biomechanical Stability of the Non-operated Eye in Asymmetric Keratoconus with Unilateral Intracorneal Ring Segment Implantation.
Article in Ophthalmology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThis study aimed to assess the tomographic and biomechanical progression of non-operated eyes in patients with asymmetric keratoconus who underwent unilateral intracorneal ring segment (ICRS) implantation.
methodsThis retrospective study included 33 patients (66 eyes) with asymmetric keratoconus who underwent unilateral ICRS implantation. The fellow eye did not meet clinical or tomographic criteria for surgical intervention at the time of the initial surgery. Tomographic and biomechanical data from the non-operated fellow eye were compared between baseline and the final follow-up (minimum 12 months). Scheimpflug-based corneal tomography (Pentacam
resultsOver a median follow-up of 31 months, non-operated fellow eyes showed no clinically meaningful changes in visual, tomographic, or biomechanical parameters, suggesting no structural progression under conservative, behavior-based management, including counseling to avoid eye rubbing, management of atopic disease, and oral riboflavin supplementation. Disease progression was observed in only two eyes (6.1%), which were subsequently referred for corneal cross-linking (CXL). ICRS-treated eyes demonstrated significant improvements in visual acuity and corneal regularity.
conclusionIn this paired-eye study, most non-operated fellow eyes in asymmetric keratoconus remained stable under conservative, behavior-based management combined with regular multimodal monitoring. These results support a behavior-first approach, using corneal tomography and biomechanics to detect objective progression and guide timely intervention. Conservative management in asymmetric keratoconus should be understood as an active, follow-up-dependent strategy rather than the absence of treatment. Surgical interventions should remain reserved for objectively progressing cases, recognizing that a small but clinically relevant proportion of fellow eyes still progress and require CXL.
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