Intracorneal ring segment (ICRS) implantation is a safe and effective surgical technique for corneal ectasia treatment with a low rate of complications. The use of a femtosecond laser for the creation of the stromal tunnel increases the safety of ICRS implantation. New ICRS with long arc length shows a higher rate of complications; therefore, its use in clinical practice should be employed with caution. A high risk of losing lines of vision after ICRS implantation is observed in those patients with good visual function prior to the procedure. It is advisable to demonstrate the stability of keratoconus previous to ICRS implantation, as halting progression of the disease has not been demonstrated with this surgical technique.