Corneal Tattooing Research Articles

The ever ongoing cosmetic quest to change eye colour.

To provide a historical overview of the various efforts to change eye colour for purely cosmetic reasons, along with the associated potential risks and harms. Literature and online search. Eye drops containing adrenaline were used during World War II on involuntary inmates of concentration camp Auschwitz-Birkenau. Prostaglandin drops, used in glaucoma therapy since 1996, can increase iris pigmentation as an undesired side effect. Commercial drops, available since 2011, are not effective and potentially dangerous. Iris implants, commercially available since 2011, led to serious complications like corneal decompensation, uveitis and glaucoma, and for this reason, implants had to be removed, leaving some patients almost blind. Also commercially in use since 2011 are laser treatments to make brown eyes blue. Among the possible complications are anterior uveitis and (pigmentary) glaucoma. Corneal tattooing has existed for almost 2000 years. Complications of modern, intrastromal keratopigmentation include corneal perforation, bacterial infection, allergic or toxic reaction to pigment, migration of pigment, and functional complications like visual field limitation and light sensitivity. Personal identity and self-esteem are likely contributing factors to undergo this potentially harmful cosmetic eye surgery. In addition to the earlier discussed complications, the artificial layer of colour can obscure ocular pathology of the cornea or iris. As the majority of individuals undergoing these procedures are relatively young, problems may arise in the future when they will need cataract or other eye surgeries. Permanently changing eye colour in healthy eyes for purely cosmetic reasons is a risky procedure.

Anterior Stromal Micro Puncture Technique for Corneal Tattooing: A Case Report

Corneal tattooing is also called as Keratopigmentation (KTP). It is used for centuries to make better the cosmetic look of corneal leucomatous opacity or scar. KTP is also helpful to manage visual symptoms link with corneal and iris malformations

The eye in forensic practice: In the dead.

Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.

Multi-lamellar Polychromatic Keratopigmentation: A Novel Approach for Corneal Tattooing

Background Corneal keratopigmentation, commonly known as corneal tattooing, is a cosmetic procedure designed to enhance the visual appearance of non-functional eyes due to congenital, traumatic, or other ocular conditions. Case Presentation This case study presents the outcomes of polychromatic lamellar keratopigmentation, a novel technique employed in three patients. The study assesses cosmetic improvements, patient satisfaction, pigment stability, and procedural complications. Results The study evaluated the outcomes of polychromatic lamellar keratopigmentation in three patients. The procedure achieved an average cosmetic improvement rating of 4.2 on a scale of 1 to 5, reflecting substantial enhancement in corneal appearance. Patients reported a mean satisfaction rating of 9.2 on a scale of 1 to 10, indicating high contentment. Pigment stability over 1 to 3.5 years was excellent, with no complications reported. This underscores the procedure's effectiveness, durability, and safety as a cosmetic enhancement for non-functional eyes. Conclusion The novel polychromatic lamellar keratopigmentation technique is highly effective, with quantifiable improvements in cosmetic appearance, exceptional patient satisfaction, and remarkable pigment stability. This procedure offers a promising and durable option for enhancing the appearance of non-functional eyes.

Adherent leukoma with iris prolapse and cataract in old farmer patient : a case report

Introduction : Adherent leukoma is a condition of the formation of white scars with the involvement of iris incarceration on the cornea, scar which has fibrous tissue adherent to its deeper surface.
 Case Illustration : a 70 year old grandfather with complaints of blurry right and left eyes, especially in the left eye there are white spots that increasingly interfere with discomfort vision in 5 months ago. The patient works as a rice farmer every day and is likely due to frequent trauma from being exposed to rice seeds since he was young. There is no history of disease and he likely to used insto eye drops. General physical examination is normal. VODS 6/15. IOP OD 11 and OS 7. There is adherens leukoma at 11 o'clock and iris prolapse and there are cataracts as well as the right and left eyes which are still thin. fundoscopy within normal limits.
 Discussion : Corneal opacity such as adherent leukoma generally results from incidental or iatrogenic trauma. In this case, the patient was traumatized showed post-traumatic cases to be the most common cause of corneal opacity (47.2%), followed by post-ulceration cases (37.7%), glaucoma (7.5%), and other unknown causes (4%). A few rare cases of non-traumatic bilateral adherent leukoma have been described to occur in association with protein energy malnutrition, vitamin A deficiency, herpetic infections and measles. Corneal tattoos and corneal transplantation have been used in treating corneal opacities with varying results.
 Conclusion : White corneal scar on leucoma represents fibrosis secondary to a previous corneal insult, most frequently trauma or infection.

Does corneal tattooing affect the conjunctival microbiota?

Purpose This study aimed to investigate the effects of commercial tattoo inks used in corneal tattooing on conjunctival microbiota. Method This prospective case control study consisted of 125 participants divided in the following three groups: 35 patients with corneal tattoos, 40 patients with corneal leukoma, and 50 healthy subjects. Corneal tattooing was performed in all the cases in this study using a tattoo pen machine and commercial tattoo ink. A total of 500 cultures were taken from 250 eyes of 125 individuals on chocolate and sheep blood agar. Bacteriological samples were taken from the inferior eyelid conjunctiva using a sterile cotton swab. Without any contact elsewhere, the swabs were smeared on bedside chocolate agars and 5% sheep blood agar. Results In tattooed eyes, bacterial growth was detected in 42.9% of the chocolate and sheep blood agar samples. In other healthy eyes of patients with corneal tattoos, 54.5% bacterial growth on chocolate agar and 57.1% on sheep blood agar were detected. No statistical difference was detected in the conjunctival microbiota of chocolate and sheep blood agar (p = 0.254, p = 0.134, respectively) in the tattooed eyes compared to the other eye of the individual. No statistically significant difference was found in terms of bacterial growth in tattooed, leukoma, or healthy eyes on chocolate and sheep blood agar (p = 0.408, p = 0.349). The growth rate of Staphylococcus epidermidis decreased by 33.3% (from 12 to 8) on chocolate agar in 35 tattooed eyes, and it decreased by 28.5% (from 14 to 10) on sheep blood agar, while gram-negative bacteria Brevundimonas diminuta, Acinetobacter lwoffii, and Psychrobacter faecalis were detected in three patients. Conclusion Corneal tattooing using commercial dye does not affect conjunctival microbiota. In the past 3 years, 120 patients have been tattooed with commercial tattoo ink in Istanbul Medeniyet University Göztepe Training and Research Hospital. No complications related to infection were found in the 3-year follow-up. The gram-negative bacteria detected in the healthy control group and tattooed eyes were bacteria found on normal skin or in the respiratory tract. Although some gram-negative bacteria do not cause infection, careful eye examination, follow-up, and culture are required in suspicious cases.

Femtosecond laser applications in corneal surgery

Abstract Femtosecond laser (FSL) applications in corneal surgery have increased since its inception. Corneal surgery has undergone a tremendous transformation thanks to the introduction of FSL technology. This laser makes precise, three-dimensional incisions while causing minimal damage to surrounding tissue. This review updates and summarizes current and upcoming FSL applications in corneal surgery, current commercially available FSL, and its respective applications. Refractive surgery applications include laser in-situ keratomileusis flaps, refractive corneal lenticule extraction such as small incision lenticule extraction, astigmatic keratotomy, intracorneal ring segments tunnels for keratoconus including corneal allogenic intrastromal ring segments, and presbyopia treatments with intrastromal pockets for corneal inlays and intrastromal incisions (INTRACOR). Keratoplasty applications include penetrating keratoplasty trephination; superficial and deep anterior lamellar keratoplasty trephination, lamellar dissection, and tunnel creation; posterior lamellar keratoplasty donor and recipient preparation; Bowman layer transplantation donor, and recipient preparation; and stromal keratophakia. Other applications include conjunctival graft preparation in pterygium surgery, and keratopigmentation (corneal tattooing). FSL is a surgical instrument widely used in corneal surgery because it improves reproducibility and safety in many procedures.

Eye Banking a Boon in Eye Health Care Services and Vision Restoration and Corneal Tattooing for Aesthetic Purposes

Eye donation and eye banking are a boon in eye health care services for visual rehabilitation and corneal tattooing aesthetic purpose in post-trauma corneal opacities. A young female reported to our hospital with a complaint of corneal opacity and difficulty in closing her left eye. On examination, she was diagnosed with a “Corneal scar with an Inadvertent bleb”. The patient reported a history of corneoscleral injury for more than four years. A slit lamp examination showed a corneal scar with a micro leak at the inferotemporal scleral region.

Aesthetic corneal tattooing/keratopigmentation using tattoo pen machine: choosing suitable method and color.

This article aims to present the corneal tattooing method and how using a tattoo pen machine can improve aesthetic appearance in patients with corneal leukoma. In this study, 42 patients were evaluated who had no visual potential and who had undergone colored corneal tattooing using an automatic tattoo pen machine for aesthetic purposes. The procedure was conducted according to the principles of the Declaration of Helsinki. The commercially available tattoo ink that has traditionally been used on human skin (brown, green, and black) for years was used for all the patients in this study, and 252 corneal photographs (with a Topcon slit lamp imaging device at 16 magnifications, i.e., 16 ×) taken within the last 2years were evaluated retrospectively. Red, green, and blue (RGB) and hue, saturation, and lightness (HSL) values of the tattooed areas, such as pupils and iris, in corneal photographs were determined online using the Color Code Finder program. The RGB and HSL values of the pupil and iris were compared before surgery on the first day and first week, first month, third month, and twelfth month after surgery. In the first postoperative month, the mean pupil lightness (L) and iris L values were found to have increased by 10.7% and 5.7%, respectively. Between the first month and the first year, the L value of the mean pupil and that of the iris increased by 1.7% and 5.2%, respectively. The increase in the RGB value of the mean pupil in the first month was statistically significant (p = 0.02). The highest increase in RGB values of the iris was observed in the first week and first month (p = 0.113). This result shows that the majority of fading occurred in the first month. After the first month, the increase in the L value in the black-colored pupil was less than that in the brown- or green-colored iris. These results show that light colors fade faster and more. Esthetically, corneal leukoma causes severe psychological problems. Many patients are unable to use prosthetic contact lenses. Evisceration surgery has many complications, and limbal stem cells are used in evisceration surgery. Corneal tattooing using a tattoo pen machine is an easy, practical, and repeatable method used for aesthetic purposes. Successful results require the use of appropriate methods, ink, and ophthalmologist's experience. All patients in this study had a more aesthetic appearance than the preoperative white eye. Further studies are needed to develop a colored aesthetic tattooing method with a tattoo pen machine.

Novel limbal dermoid surgery for visual acuity and cosmesis improvement: A 7-year retrospective review.

To report a long-term outcome of the novel combined surgical method of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft for limbal dermoid. All patients who were referred to our clinic for limbal dermoid, and underwent a combined surgery of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft were retrospectively reviewed. The surgery was performed by one surgeon, and all clinical information was obtained during a seven-year follow up period. In all patients, surgical outcomes of cosmesis, best corrected visual acuity (BCVA), spherical equivalent (SE), and corneal/ocular astigmatism were obtained and compared preoperatively and postoperatively. During seven years, 24 patients (24 eyes) with limbal dermoid were finally enrolled. The mean age was 10.1±8.9 years old. The surgery resulted in an improved appearing ocular surface in all cases without any complications. There was no statistical difference in BCVA, corneal and ocular astigmatism between preoperatively and postoperatively (p = 0.231, 0.156 and 0.475, respectively). The mean SE was 0.12±3.19D preoperatively, and -0.21±3.02 D postoperatively with statistical significance (p = 0.037). Mean follow up period was 54.50 ± 15.62 months. Based on the results of this study, our innovative surgical method which includes complete excision with corneal tattooing and limbal conjunctival autograft can be a simple and safe procedure that achieves long standing cosmesis with limbal dermoids.

A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair

Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient’s symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up.

Technical and Clinical Complications of Cosmetic Tattooing.

Cosmetic tattooing and medical tattooing of the face share basic principles and to some degree types and spectrum of technical and clinical complications known from decorative tattooing of other parts of the body. Cosmetic tattoos recently have grown exponentially in popularity in industrialized countries all over the world. The different complications and their clinical symptoms, pathophysiology, diagnosis, treatment, and prevention are analyzed versus culprit pigments and updated. Eyeliner tattooing is associated with special complications because of the subtle anatomy and the closeness to the eye, and the risk of meibomian gland damage. The spectrum of cosmetic tattoo complications includes early-onset complications (infections particularly with herpes simplex, healing issues, aesthetic and technical mistakes with regret), and late-onset complications (color fading and color shift, "blowout" pigment escape to surrounding skin, papules, nodules, granulomas associated with sarcoidosis, allergic reactions in lip tattoos with lichenoid dermatitis, eye irritation, and fibrosis and scaring especially after microblading); miscellaneous complications include severe burn sensation in tattoos during magnetic resonance imaging later in life. Corneal tattooing and subconjunctival/episcleral tattooing performed on medical indication by ophthalmologists, and for decoration by tattooists carry special risk of intraocular complications. It is recommended for the purpose of research harmonization that terms and diagnostic classification of tattoo adverse events follow the system introduced by the Tattoo Clinic of Copenhagen and already accepted in specialized tattoo clinics in other centers.

Artificial iris implantation in congenital aniridia: A systematic review

Congenital aniridia is a rare, panocular disorder with a main phenotypic characteristic of a partial or complete absence of the iris existing alongside other ocular morbidities such as cataract, keratopathy, optic nerve and foveal hypoplasia, and nystagmus. The iris abnormality, however, often leads to symptoms such as photophobia, glare, and decreased visual acuity, as well as cosmetic dissatisfaction. Current management options for the iris deficit include colored iris contact lenses, corneal tattooing, and tinted contact lenses. Symptoms arising from small iris defects can be resolved with surgical management using micro-tying suture techniques such as McCannel or Siepser. Currently, larger iris defects can be treated with artificial iris implants. New prosthetic options range from colored intraocular lenses to flexible custom-made silicone iris implants. With a range of therapeutic options available and given the challenges of multiple comorbidities in aniridia, we evaluate the literature relating to the use of artificial iris implants in congenital aniridia, with a focus on the different surgical implantation techniques, the clinical outcomes achieved, complications occurred, and risk of bias of the studies included.

Keratopigmentation for the Scarred Cornea

Corneal tattooing or keratopigmentation (KTP) is a very useful method for aesthetic purposes to camouflage white corneal scars in eyes with no visual potential. Various techniques of KTP exist, dyes are applied to the anterior stroma following epithelial debridement or trans-epithelial needle puncture. In this case report we intend to report outcome in terms of colour distribution and stability by using KTP technique where dye is applied directly into the stroma. In conclusion, corneal tattooing employing stromal puncture technique in extremely adhered scarred cornea is cosmetically promising but it requires proper preoperative assessment and intraoperative graded stromal puncturing makes it an efficient and technically demanding.

Intrastromal Keratopigmentation with Micronized Gold

A 63-year-old man with retinitis pigmentosa presented to the outpatient clinic for blurred vision. The best-corrected visual acuity was 20/200 and 20/400, respectively, in the right and left eyes. Slit-lamp examination showed sclerotic cataracts in both eyes and several circumferential intrastromal keratopigmentations with micronized gold at the periphery of both corneas (Fig. 1). The patient stated that corneal tattooing was per-

Clinical profile of infectious crystalline keratopathy – Case series with varied risk factors and etiology

This case series of six patients with infectious crystalline keratopathy (ICK) aims to highlight the varying risk factors, clinical presentation, and its outcome. We also report a post DALK (deep anterior lamellar keratoplasty) and post corneal tattooing infection uniquely presenting as ICK. The most common etiological organism (four out of six) was the Streptococcus species. Two other rare organisms identified were Burkholderia cepacia and Candida albicans. Five out of six patients healed with medical treatment with an overall average duration of 7 weeks (2–14 weeks), and only one patient required therapeutic penetrating keratoplasty.

Long-Term Outcome of Femtosecond Laser-Assisted Keratopigmentation: Using Intacs Channels for Precise Pigment Deposition Within the Cornea.

To describe a long-term outcome of a new technique using the femtosecond laser to assist with keratopigmentation (corneal tattooing). Nineteen eyes of 18 patients with a history of significant visual disability related to iris defects underwent femtosecond laser-assisted keratopigmentation (FAK) for functional restoration of their visual disabilities. Postoperative visual acuity and symptomatic resolution were collected during their postoperative visits. After FAK surgery, all patients had improvement in their previous visual-related symptoms. Eighteen of 19 eyes (94%) had improvement in their best-corrected Snellen visual acuity. Eight of 19 eyes (42%) had at least 1 line improvement, 8 of 19 eyes (42%) had at least 2 lines of improvement, and 2 of 19 eyes (10%) had at least 3 lines improvement. The average follow-up period was approximately 60 months. The FAK technique offers a long-term effective and safe technique for visual disabilities and improves visual acuity in patients with various traumatic iris defects.

A novel indigenous technique for corneal tattooing using self-prepared do-it-yourself carbon soot pigment.

Purpose:To evaluate the cosmetic efficacy and safety of an indigenous novel corneal tattooing technique using a self-prepared candle soot pigment.Methods:This pilot observational study involved 22 eyes of patients at a Bengaluru-based ophthalmology setting. The study considered only eyes with nil or low visual potential. Eyes with active ocular inflammation, nasolacrimal obstruction, severe hypotony, and shrunken globe due to phthisis bulbi were excluded. The surgery was carried out under aseptic conditions using a self-prepared carbon soot pigment. Different methods such as lamellar, surface needle micropuncture, machine-assisted surface tattooing, or a combination were used for pigment application.Results:Ten eyes underwent combined lamellar and surface tattooing; lamellar tattooing was performed for 11 eyes, and surface tattooing for one eye. Nineteen patients underwent limbus-to-limbus corneal tattooing and three patients had undergone focal tattooing to cover nasal pterygium scar, inferior iridectomy, and leukocoria due to calcific cataract. Nearly 91% were subjectively satisfied with the tattooing technique and 82% had excellent cosmetic coverage along with subjective satisfaction. None of the subjects required a repeat surgery or augmentation of tattooing. There was no reported case of corneal inflammation, epithelial erosions, infiltrations, infections, nonhealing areas, stromal melting, or any other complications.Conclusion:This novel procedure, involving self-prepared carbon soot pigment tattooing, provides excellent cosmetic results and high patient satisfaction. It is relatively safe, easy to perform, and the conventional steps of tattooing such as pigment procurement, storage, and sterilization can be avoided, as the carbon pigment is freshly prepared under aseptic conditions.

Simple and novel technique of using lampblack soot as a corneal tattoo for disfiguring corneal opacities

The aim of this study was to report a series of corneal tattooing in three eyes of three patients with disfiguring corneal scar and no visual potential, which underwent the procedure using the lampblack prepared in the operating room (OR), and to describe the novel technique of lampblack preparation for the surgery. The depth of corneal opacity was carefully assessed and a superficial lamellar pocket was made by lamellar separation using corneal dissectors, following which the prepared lampblack soot using materials available in the OR was deposited in the pocket. At a mean follow-up of 6 months, all the eyes had a stable corneal surface with an acceptable cosmetic outcome. Corneal tattoo using lampblack gives a satisfactory cosmetic result with good patient satisfaction and improved quality of life in the eyes with disfiguring corneal scar.

Corneal tattooing in a case of keratoconus with posthydrops scarring

Corneal tattooing in a case of keratoconus with posthydrops scarring