Corneal Tattooing: Keratopigmentation As A Cosmetic Treatment For Disfiguring Opacified Corneas

To report the outcomes of keratopigmentation in cases of aesthetic complaints due to chronic unilateral total corneal opacity and the perception of patients about the effectiveness of corneal tattooing for the cosmetic improvement of their eyes with leukoma. 

Tertiary university public hospital. 

Five eyes of five patients (four males and one female) with total corneal opacification with visual acuity of light-perception or no light perception were included. They were all contact lens intolerant or unwilling to use a cosmetic contact lens. Corneal tattoo was performed by applying a medical-grade tatoo dye into a manually-dissected pocket in the corneal stroma. In all patients, a deeper (250-350µm) pocket was created and filled with a dark brown dye to simulate the iris and a shallower (150-200µm) 3.5 mm-central circular pocket was filled with black dye to simulate the pupil. The main outcomes were surgical complications, pigment stabilization, postoperative patient's cosmetic appearance and discomfort. 

The mean follow-up time was 4-12 months. All patients were very satisfied with the cosmetic results and reported significant improvement in self-esteem and social well-being. 80% of patients said they had little postoperative discomfort, while 20% reported moderate discomfort. No ocular or corneal complications occurred during or after surgery. Minimal pigment loss was seen in 2 patients, but the cosmetic results were satisfactory, and no secondary surgical procedures were required one year after surgery in any of the patients. 

Keratopigmentation can be an alternative method to contact lenses and ocular prostheses in impaired eyes with corneal opacities. It can bring satisfactory and long-lasting cosmetic improvement that can enhance social acceptance for these patients