如今圆锥角膜的诊疗理念不断更新，人们不仅关注于如何延缓圆锥角膜进展，也在努力提高患者的视觉质量。随着准分子激光和飞秒激光技术在眼科的应用，角膜胶原交联术联合不规则角膜准分子激光切削术的治疗方案已成为圆锥角膜治疗的新策略。然而已逐渐变薄的圆锥角膜患眼是否可再进一步行准分子激光切削、该方案两种手术同期和分期执行孰优孰劣等关键问题尚无定论，本文基于这两个关键问题展开论述，以期为临床合理选择最优化的解决方案提供指导。n （中华眼科杂志，2021，57：251-253）“,”The concept of diagnosis and treatment of keratoconus is constantly updated. Today, we are not only concerned with how to delay the progress of the disease, but also with the preservation of useful vision for patients as well as improvement of visual quality. With the precise and individualized application of excimer laser and femtosecond laser technology in ophthalmology, corneal cross-linking combined with excimer laser ablation for the irregular cornea has become a new strategy for keratoconus. However, questions have been raised and caused ophthalmologists′ thinking. Are patients with keratoconus who have progressively thinned corneas suitable for excimer laser ablation? Which is better when the combined strategy is applied, simultaneous or sequential surgery? Based on the research data from home and abroad, we comprehensively sort out various treatment methods for the focus issues. It is hoped that this article can provide guidance for the rational selection of an optimal clinical solution to keratoconus. n (Chin J Ophthalmol, 2021, 57:251-253)