|Year : 2019 | Volume
| Issue : 1 | Page : 68-70
White to black: Keratopigmentation
Nishanth Madhivanan, PA P. Aysha, Shruti Nishanth, Nivean Madhivanan
Department of Cornea and Refractive Surgery, MN Eye Hospital Pvt. Ltd., Chennai, Tamil Nadu, India
|Date of Web Publication||10-Jun-2019|
Dr. P A P. Aysha
MN Eye Hospital Pvt. Ltd., 781, TH Road, Tondiarpet, Opp. Tondiarpet Police Station, Chennai - 600 021, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Here we report a case of 34 year old female who presented to our department with chief complaints of photophobia, glare and whitish colouration of cornea in the left eye since 5 months. She had a history of penetrating ocular injury at the age of 6. She underwent penetrating keratoplasty, followed by cataract extraction and Intraocular lens implantation in 2015. On examination, Visual Acuity of right eye was 6/6 and left eye hand movements with projection of light in all quadrants. Slit lamp examination of left eye showed graft failure with leucomatous corneal opacity. Keratopigmentation was done using tattooing gun and jet black dye. Patient became symptomatically better and cosmetically satisfied. We found there was no fading of colour after three months.
Keywords: Corneal tattooing, leucomatous corneal opacity, penetrating keratoplasty
|How to cite this article:|
Madhivanan N, P. Aysha P A, Nishanth S, Madhivanan N. White to black: Keratopigmentation. TNOA J Ophthalmic Sci Res 2019;57:68-70
| Introduction|| |
Corneal tattooing has been used for cosmetic treatment of corneal opacities for centuries., Galen (AD 131–120) is considered to be the first to pigment human cornea using a reduced copper sulfate to mask a corneal leucoma.,, Later, some surgeons experimented with different combination of various chemical products such as Indian ink, organic colors, animal uveal pigment, metallic borders, Chinese ink, platinum, and gold chloride. The main limitations in previous studies were fading of colors over time. The literature also mentions von Weckerin back in 1870 who used India ink into a scarred cornea.
| Case Report|| |
A 34-year-old female presented to our department with chief complaints of photophobia, glare, and whitish discoloration in the left eye for 5 months. Her ocular history revealed penetrating injury to the left eye with a stick 28 years back followed by decreased vision. She had undergone penetrating keratoplasty followed by cataract extraction and intraocular implantation 3 years back. One year back, she developed graft failure with leucomatous corneal opacity.
On ocular examination, uncorrected visual acuity in the right eye was 6/6 and N6 and left eye-hand movement with projection of light in all quadrants. On slit-lamp examination, right eye was normal and left eye had a graft failure with leucomatous opacity with no visual potential as she was densely amblyopic in that eye [Figure 1]. Fundus examination of the right eye was normal and left eye had hazy view.
B scan of both eyes was normal.
Systemic examination was found to be in normal limits.
Routine blood investigations were normal.
On pachymetry, corneal thickness of the right eye was 520 μ and left eye 540 μ.
The patient was not willing for visual rehabilitation procedure but was interested in good cosmesis.
The patient was planned for corneal tattooing of the left eye under topical anesthesia.
The epithelium was scraped off using a number 15 blade. A drop of black tattoo ink was put on corneal surface using 26-gauge 1cc needle, and micropuncture was performed using the gun of the tattooing machine. The gun of the machine is kept perpendicular on the cornea and moved along the surface gently and softly [Figure 2]. This maneuver is repeated multiple times on the area in cornea to be tattooed until final cosmesis is achieved. Bandage contact lens is placed with routine postoperative medication such as low-dose steroids, antibiotics, and lubricants [Figure 3].
|Figure 2: (a) Machine, (b) sterile needle, (c) needle length adjustment, (d) tattoo ink|
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|Figure 3: (a) Epithelium scraping, (b) ink application, (c) micropuncture with tattoo gun, (d) tattooing, (e) saline wash, (f) bandage contact lens placement|
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Her postoperative period was uneventful with cosmetically better and no fading of color after 3 months [Figure 4] and [Figure 5].
| Discussion|| |
The main indications for corneal tattoos are leucomas, aniridia, polycoria, and corneal scars. Although tattoos are often given to patients who have end-stage opaque corneas, the procedure can also be performed on patients who are more interested in cosmesis than visual rehabilitation for leucomatous cornea. The corneal tattoo procedure is also a viable alternative to a corneal transplant with no visual potential and a good adjunctive therapy that helps minimize the psychological impact of opaque corneas or cosmetically unacceptable scars.
The machine (PMT/MTS) is made by a Chinese manufacturer who is well known in the field of cosmetic tattooing. The package contains the machine and disposable sterile needles are purchased separately. The ink which used was presterilized by gamma irradiation and is approved for dermal pigmentation. The machine is rotary and easy to use. There is a small motor encased in each rotary tattoo machine that moves the attached tattoo needle up and down. Sterile precaution is followed while using the tattoo gun, i.e., a sterile cloth cover over the probe and a disposable sterile plastic sleeve over the wiring. Only needle cartridge is exposed over the surgical field. There is dial on tattoo pen with which we can adjust the depth from 0 to 3.5 mm, usually a depth setting around 0.5 mm or less suffices for the procedure. However, it can be adjusted depending on the pre-existing thinning or a thick, scarred cornea.
| Conclusion|| |
Keratopigmentation has achieved good cosmetic and symptomatic results and is associated with high patient satisfaction. Corneal tattooing is a very safe, easy, and cost-effective method to achieve cosmetic results.
Future potential option
Femtoassisted cornea tattooing is a new technique that has been proposed for the treatment of an opaque cornea for cosmetic purposes.,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]