Keratoconus: Breaking paradigms and contradictions of a new subspecialty

with crosslinking as in the Athens protocol (top-guided therapeutic PRK and crosslinking) described by Kanellopoulos, (20) and the Cretan protocol (PTK for debriding epithelium and crosslinking) described by Kymionis et al., (21) among others. The surface ablation can also be carried out after ring segment implantation, as described by Ertan et al. and Coskunseven et al. (22,23) In addition, phakic lenses may be indicated in cases of keratoconus. (24-26) Still regarding the advances of Refractive Surgery applied to the management of keratoconus, we can mention the improvements in the excimer laser to make customized plans based on topography exams or corneal tomography or ocular aberrometry, and the revolutionary femtosecond laser with different applications in surgeries for keratoconus. (27) For the ring segment implant, the creation

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