Planning of Intrastromal Corneal Ring Surgery: We are Still Far from a Consensus

Introduction: For the intrastromal ring implant surgery, there are nomograms that guide the appropriate selection of segment models to be used, in addition to detailing the surgical planning.However, most physicians prefer not to consider the guidelines of the nomograms, following their intuition and experience, in addition to asking for the opinion of colleagues.This study aims to study the diversity of physicians' conduct in corneal ring surgery.Materials and methods: In 2017, the data of a patient were distributed for analysis by 16 physicians with recognized experience in the treatment of keratoconus patients.They were asked to suggest what would be the best treatment proposal.This same case was sent again to the same 16 physicians in 2024, and they were asked for their suggestion for the ideal conduct.The responses obtained were compared with each other and it was observed whether the suggested treatment was changed from 2017 to 2024.Result: In 2017, 14 different suggestions were obtained among the 16 participating physicians.In 2024, no treatment suggestions were repeated.Comparing the suggestions from 2017 with those from 2024, only two doctors maintained the same treatment proposal.Conclusion: There is still a wide divergence of opinion regarding the planning of corneal ring implant surgeries.The union of doctors' experience through the construction of a collective database (www.keratoconusstudygroup.com), allowing the exchange of good and bad experiences obtained in corneal ring surgeries, can facilitate the study and research of this treatment modality, allowing a consensus building in the future.