ICL surgery is generally approached very cautiously in keratoconus and is often not the first‑line option.
Why keratoconus complicates ICL planning
The cornea may remain highly irregular.
- ICLs correct internal focus but do not regularise a cone‑shaped cornea
- Residual irregular astigmatism may still require rigid or scleral lenses
- Higher risk of eye rubbing, inflammation, or pressure‑related issues
- Need to ensure keratoconus is stabilised, often with cross‑linking, first
- Visual potential limited if scarring or advanced thinning is present
When ICL might be considered
Selected cases may benefit after specialist review.
- Stable, treated keratoconus with good vision in rigid or hybrid lenses
- Intolerable spectacle or contact‑lens corrections despite stability
- Combination strategies with cross‑linking and customised laser for regularisation
- Detailed consent about uncertainties and the likely need for lenses post‑ICL
- Management within a specialist cornea and refractive centre
