The management of keratoconus has evolved substantially over 3 decades.
While corneal transplantation was historically the only surgical option for advanced disease, intracorneal ring segments (ICRS), first implanted by Walton Nosé in 1993 and later popularized by Joseph Colin, offered a less invasive way to improve corneal symmetry and reduce irregular astigmatism. Conventional ICRS are made of synthetic PMMA, and despite their efficacy, they carry substantial risks, including extrusion, corneal melt, neovascularization and stress-induced stromal necrosis, particularly when placed