ABSTRACT Objective: To evaluate refractive and topographic outcomes before and at least 7 years after intrastromal ring segment implantation surgery in patients with keratoconus. Methods: Long-term retrospective longitudinal study carried out with 35 patients (62 eyes) aged 10 to 30 who underwent intrastromal ring segment implantation using a manual technique. Different arc rings were analyzed across various keratoconus types. Results: Significant improvements in topographic astigmatism (p = 0.001) and corrected distance visual acuity (p < 0.001) were observed, with no [...]