Corneal Cosmetic Tattoo Using Phemtosecond Laser Created Pocket

To present a case study of a 67-year-old female patient who underwent corneal tattooing as a cosmetic intervention for a phthisical eye with corneal leucoma.

Gemini Eye Clinic, Zlin, Czech Republic

A 67-year-old female patient presented with a blind phthisical left eye following a history of fakotoxic uveitis, retinal detachment (30 years prior), and chelation therapy (2009). Clinical examination revealed cosmetically prominent white eye with a mild exotropia, limbal telangiectasia and perilimbal vascularization, zonular keratopathy. Behind the white cornea was detected a wide pupil, peripheral iris atrophy with anterior synechiae, and a mature, slightly subluxated cataract. Due to significant aesthetic concerns, corneal tattooing with black pigment was performed. Firstly, a corneal pocket with 5.5 mm diameter and a 2 mm incision was created under topical anesthesia using the femtosecond laser ATOS (SCHWIND eye-tech-solutins, Germany). Following only partial incision, opening only on its side, a black pigment was injected via cannula and spread in the pocket as evenly as possible. The procedure was uneventful and postoperative topical antibiotics and steroid drops were administered. 1 week postoperatively the corneal tattoo provided a satisfactory cosmetic outcome. No postoperative complications, such as pigment dispersion, corneal thinning, or inflammation, were observed during 6 months follow-up. The patient reported high satisfaction with the aesthetic enhancement.

Corneal tattooing using the femtosecond laser system is a viable and minimally invasive technique for improving the cosmetic appearance of a blind eye with a white cornea. This case demonstrates its effectiveness in addressing patient concerns in cases of phthisis bulbs, providing an alternative to prosthetic solutions or enucleation.