Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint

Cosmetic Therapeutic Keratopigmentation

Purpose

To analyze indications safety and potential complications of cosmetic therapeutic corneal keratopigmentation to treat disfiguring aspect of opaque corneas.

Methods

Eight eyes of 8 consecutive patients were enrolled in therapeutic corneal keratopigmentation. Surgery was performed using manual technique, and a two-plane corneal dissection was performed. In the deeper pocket, brown pigment was injected to mimic iris color. In the more superficial and smaller pocket, black pigment was used to simulate pupillary opening.

Results

Seven out of 8 eyes had significant improvements in cosmesis after surgery. One patient did not have a major improvement due to significant superficial corneal neovascularization. In two eyes, there was pigment fading in the postoperative period, but no additional surgeries were performed. No complications were noted in any of the patients.

Conclusion

Therapeutic corneal keratopigmentation can lead to a significant change in ocular appearance and may improve self-esteem and overall life quality. Pigment fading and corneal neovascularization can be a potential problem. Careful patient selection and counseling are important to avoid patients seeking unachievable results.

Corneal Ectasia Following Cosmetic Keratopigmentation

PURPOSE

The purpose of this study was to describe 5 cases (10 eyes) that, following purely cosmetic femtosecond laser-assisted keratopigmentation (KTP), showed evolution toward corneal ectasia during a variable postoperative period.

METHODS

In a case series, 5 patients after bilateral purely cosmetic KTP showed progressive changes in topographic, refractive, and even in visual performance values manifesting from 6 months to 4 years following the procedure. A femtosecond laser-assisted cosmetic intrastromal KTP technique was performed in all patients using micronized mineral pigments. Two patients underwent a retouch using superficial automated KTP to optimize cosmetic outcome.

RESULTS

All patients preoperatively demonstrated normal corneal topography with no intraocular pathology and unimpaired visual acuity. One of the cases developed corneal ectasia after magnetic resonance imaging, another confirmed intensive eye rubbing due to allergic conjunctivitis, and 1 patient underwent previous myopic laser in situ keratomileusis procedure. The rest did not show any preoperative clinical evidence potentially related to the development of the keratectasia. One case rather demonstrated modification of keratometry (K) values than a clear corneal ectasia. Three cases were treated with epi-off corneal cross-linking.

CONCLUSIONS

Corneal ectasia is a potential complication after cosmetic KTP and should be included in the preoperative informed consent. A comprehensive preoperative screening is necessary to exclude suspicious cases, and patients should be instructed to avoid eye rubbing and other maneuvers that could affect the potential development of this complication.

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