Tomographic and Biomechanical Stability of the Non-operated Eye in Asymmetric Keratoconus with Unilateral Intracorneal Ring Segment Implantation

In 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.