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

PURPOSE: 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. METHODS: 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 2 years 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. RESULTS: 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. CONCLUSION: 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.

The safety and effectiveness of a novel annular keratopigmentation technique; a cross-sectional survey of patients.

PURPOSE: We investigated safety aspects and other patient experiences related to a novel Femtosecond Laser Assisted Annular Keratopigmentation technique (FLAAK). SETTING: Espace Nouvelle Vision Clinic in Paris. METHODS: Monocentric, post-operative, cross-sectional survey of patients who returned to the clinic for a color correction after the FLAAK procedure. Whilst waiting for their color retouch, consenting patients completed a questionnaire about their experiences following the FLAAK procedure. Aspects related to side-effects or discomfort as well as patient satisfaction were assessed. RESULTS: The questionnaire was completed by 42 of 51 patients returning to the clinic for a color retouch (27 females, 15 males; mean age 37.6 years). Pain was experienced by 34 (81%) patients, dry eyes by 32 (76%) patients, glare by 23 (56%) patients, red eyes by 28 (67%) patients, and tingling by 30 (71%) patients; no patient experienced visual halos. All experienced post-operative symptoms were of a transient nature. Symptoms like pain, tingling, glare and red eyes disappear in less than 48 h after surgery in approximately 50% of the cases, and ocular dryness in 22% of cases., The median duration of these symptoms in patients for whom the symptoms were still present after 48 h, is 7 days. Patient satisfaction with the aesthetical result (scale ranging from 0 to 10) was on average 8,1 (SD 1,6). CONCLUSION: The FLAAK procedure performed for purely aesthetic purposes appears to be safe and is associated with high patient satisfaction.

Intrastromal keratopigmentation: a boon for unsightly corneal scars.

PURPOSE: The aim of this study was to improve cosmesis in patients with corneal opacity (CO) using newer organic micronized pigments. METHODS: Settings: Tertiary Care eye center, Design: Retrospective study. INCLUSION CRITERIA: Patients with unsightly corneal scars not suitable for keratoplasty, eccentric corneal opacity not requiring keratoplasty, or lenticular opacity/anterior or posterior capsular opacities in non-seeing eyes. Micronized organic pigment was used for keratopigmentation by the intrastromal pocket technique (ISPT) in deep corneal opacities and lenticular opacities, whereas the intrastromal needle puncture technique (ISNT) was used in superficial opacities or corneoiridic scars. The records of 463 patients were reviewed and analyzed for the duration of the past 7 years. RESULTS: Two hundred and ninety-three (63.2%) patients underwent ISNT, eight underwent combined technique, and the rest underwent ISPT. The postoperative follow-up period showed more watering and redness in the needle puncture technique (p > 0.001), which resolved in 70.4% of patients by the end of 4 weeks. Repeat procedures were required in 5.3% of the patients with ISNT. The patient's satisfaction grading showed excellent levels in 375 (80.9%) patients, 45 (9.7%) had good satisfaction levels, and the rest had average satisfaction levels. CONCLUSION: Intrastromal keratopigmentation is a boon for unsightly corneal scars and gives respite to the patients from the social stigma.

Femtosecond assisted keratopigmentation (FAK) with a 5-millimeter diameter aperture does not affect ocular examination.

AIM: to assess the feasibility of performing a screening of ocular pathologies after Femtosecond laser Assisted Keratopigmentation (FAK) procedure in normal eyes with the aid of multimodal imaging technologies. DESIGN: A Retrospective cohort study. PARTICIPANTS: Thirty consecutive international patients (60 eyes) who underwent FAK for purely aesthetic reasons were chosen for this study. METHODS: Data from medical records of 30 consecutive patients were retrieved after performing tests 6 months after surgery. Clinical examinations were performed by three ophthalmologists. MAIN OUTCOME MEASURES: The main purpose of this study was to see if routine examinations are feasible in patients operated on by the FAK and if the results can be interpreted as easily as in non-operated patients. RESULTS: Sixty eyes of thirty consecutive patients that underwent a screening of ocular pathologies at 6 months post FAK were included. 60% were female and 40% were males. Mean age was 36 years +/- 12 years. Screening of ocular pathologies using multimodal imaging tests or clinical examination was performed without any difficulties in acquisition or interpretation in 100% of patients (n = 30) except the endothelial cell count of the corneal periphery which was not possible. The direct examination of the iris periphery was possible at the slit lamp through the translucid pigment. CONCLUSIONS: The screening of ocular pathologies after purely aesthetic FAK surgery is feasible, except for pathologies of the peripheral posterior cornea.

Cosmetic Change of the Apparent Color of the Eye: A Review on Surgical Alternatives, Outcomes and Complications.

An increasing number of people are seeking elective cosmetic change of eye color. We review the surgical techniques, outcomes and complications arising from the various existing surgical alternatives, including cosmetic iris implants-which based on the available evidence should be considered malpractice-as well as laser iris depigmentation and cosmetic keratopigmentation. Laser iris depigmentation has been used clinically for aesthetic purposes without receiving official approval or licensing. The technique can be performed in an outpatient clinic thanks to the use of neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers, but scientific literature data about this treatment is very limited. Cosmetic iris implants are neither CE-marked nor Food and Drug Administration (FDA)-approved, and lead to severe complications arising from their placement including uveitis, hyphema, glaucoma, cataract, corneal endothelial damage and severe vision loss. Management of complications resulting from iris implants might require several surgical procedures, and the follow-up is difficult among these poorly informed patients. Keratopigmentation is the most extensively studied technique and had long been investigated before being introduced into clinical practice: already introduced centuries ago, it was recently developed, reporting adequate levels of safety and efficacy. The medium- and long-term cosmetic outcomes of keratopigmentation and patient satisfaction have been the subject of recent reports. The available level of evidence suggests that cosmetic keratopigmentation is the best evidence-supported surgical choice for patients seeking a permanent cosmetic eye color change. Still, additional investigation is needed to optimize the outcomes, minimize postoperative complications and further develop this and other new surgical alternatives such as laser procedures.

Intrastromal keratopigmentation for photophobia secondary to traumatic aniridia.

Purpose: To present a case of therapeutic intrastromal keratopigmentation to resolve intractable photophobia secondary to traumatic aniridia in a hypotonus eye. Observations: A 66-year-old male presented with intractable photophobia for several years in the left eye following a ruptured globe and multiple subsequent retinal surgeries for retinal detachments complicated by proliferative vitreoretinopathy. The patient underwent intrastromal keratopigmentation given surgical limitations due to the presence of hypotony and silicone oil dependence. The patient's symptoms were fully resolved, and the pigmentation remained stable at 18 months. Conclusions/Importance: Keratopigmentation can be an effective surgical approach to managing patients with symptomatic photophobia in eyes where intraocular surgery is not an amenable option.

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.

Modified head inversion technique for pterygium and pseudopterygium surgery combined with keratopigmentation.

PURPOSE: We describe a single sitting modified technique of pterygium surgery along with corneal tattooing for combined cosmetic rehabilitation in eyes with corneal opacity and pterygium or pseudopterygium. METHOD: Five patients with corneal opacity due to healed keratitis/optically failed therapeutic grafts along with pterygium or pseudopterygium underwent combined pterygium surgery by head inversion technique and corneal tattooing in the same sitting. All patients had no visual prognosis in that eye and surgery was indicated for cosmetic reasons only. RESULTS: At 6 months follow up no complications of pterygium surgery like recurrence, thinning, dellen, infections were noted in any patient. The dye was retained in the cornea and the cosmetic rehabilitation was excellent in all patients. DISCUSSION: Corneal tattooing combined with pterygium/pseudopterygium surgery can be performed in a single sitting with this novel technique in eyes with no visual potential. This is particularly suitable for eyes with limbal stem cell deficiency or large pterygia/pseudopterygia where conjunctival autograft is not advisable. These patients are often apprehensive for an allograft from their only seeing other eye.

Crystalline lens alterations in congenital aniridia. / Alteraciones del cristalino en la aniridia congénita.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.

Crystalline lens alterations in congenital aniridia.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.

Keratopigmentation: Is it a Miracle or an Adventure?

OBJECTIVES: This study is an analysis of the cosmetic and functional results of patients who underwent keratopigmentation (KTP). METHODS: Sixteen eyes of 16 patients, 7 females (43.75%) and 9 males (56.25%) were included in the study. Intrastromal and superficial manual KTP were performed under general anesthesia. Patients with no light perception or with only light perception but total corneal opacification, prosthetic contact lens intolerance, or unwillingness to use a contact lens were studied. The main outcomes were postoperative patient's satisfaction, cosmetic results, pigment stabilization and surgical complications. A grading system (0-5 points) was used to assess patient satisfaction and the cosmetic results. RESULTS: The mean age of the patients was 30.5±12.06 years (range: 16-53 years). Black pigment was used in 10 patients (62.5%), a brownish color in 5 patients (31.25%) and a greenish, yellow, blue, and black color pigmentation was used for 1 patient (6.25%). The mean follow-up was 29.31±15.45 months (range: 8-52 months). In 2 of 16 patients, mild to moderate pigment loss was seen 12 months after the surgery and superficial KTP was repeated. Minimal pigment loss was seen in 5 patients, but the cosmetic results were satisfactory and no secondary surgical procedure was required. Pigment leakage underneath the conjunctiva was seen in only 1 patient. Otherwise, there were no complications associated with keratopigmentation. The postoperative mean patient satisfaction score was 4.18±0.75 points (range: 3-5 points). CONCLUSION: KTP is a safe surgical procedure that is easy to learn and perform, does not require expensive materials, and avoids more extensive and invasive reconstructive ocular procedures. Corneal KTP may have a great impact on future ophthalmic surgical practice from both therapeutic and cosmetic perspectives.

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

BACKGROUND: Therapeutic corneal pigmentation has modernly evolved into different sophisticated techniques to camouflage cosmetically disabling corneal opacities and scars with good reported outcomes. Blind eyes frequently suffer from strabismus which further deteriorates the cosmesis of the patient. Combined keratopigmentation (KTPG) with strabismus surgery may be an option for these patients. METHODS: A total of 72 consecutive patients were retrospectively reviewed in this investigation. Main outcome measures were postoperative residual squint, and cosmesis evaluated by an independent observer, patient satisfaction, reoperation rates for KTPG and squint, and complications. RESULTS: A total of 72 consecutive patients and 73 eyes that underwent KTPG and strabismus surgery were included in this study. Mean follow-up time was 2.5±3 years. Patient age ranged from 5 to 83 years, with 93% having visual acuity worse than 0.1. 14 eyes (24.5%) underwent repeated KTPG, 24 (42.1%) had repeated strabismus surgery. 14 patients (19.4%) had a repeat muscle surgery, although 55 (76.4%) of the 72 patients achieved orthotropia or had deviations within 10 prism dioptres at the end of the follow-up period. Corneal microperforation was encountered in two (2.8%) patients and conjunctival staining in 10 eyes. Cosmesis was good for all patients. Patients who required repeat KTPG or strabismus surgery, or those in whom orthotropia was not totally restored, considered their cosmetic appearance sufficiently improved. CONCLUSION: Corneal KTPG combined with strabismus surgery provides good cosmesis for patients with corneal scarring and strabismus with minimal complications. Reoperation rates are relatively high in the short term to accomplish an optimal cosmetic result.

Keratopigmentation (Corneal Tattoo) - Our First Experience.

INTRODUCTION: Keratopigmentation or corneal tattooing represents an unique cosmetic solution for corneal leucomas and also for other pathological changes affecting cornea or iris. Procedure is based on pigment insertion into the corneal stroma. Goal is to improve the appearance of the affected eye. These days are most frequently used tattoo kits with different sterilised inks made primary for skin tattooing. As a new possibility there are also available biocompatible micronized mineral pigments. METHODS: Authors will introduce four case reports of four patients with corneal leucomas, who wanted to undergo the corneal tattooing to improve the cosmetic appearance of their blind eyes. Authors decided for keratopigmentation with an use of inks intended primary for skin tattooing. RESULTS: In all four patients was the final appearance of tattooed cornea more than satisfying. Postoperative examination didn´t detect diffusion, fading, colour changes of the pigments. No complications such as toxic or immune reaction due to the pigment were recorded. All four patients were subjectively fully satisfied with the cosmetic result of the keratopigmentation. CONCLUSION: Based on the first experience authors consider keratopigmentation to be a safe and relatively uncomplicated surgical method. Corneal tattooing is also quite cheap, does not require patient´s hospitalization and postoperative reconvalescence in usually short term. Key words: keratopigmentation, corneal tattoo, corneal leucoma, blind eye.

Inadvertent corneal pigmentation following cosmetic blepharopigmentation.

PURPOSE: To present a case of inadvertent corneal pigmentation as a complication of cosmetic eyelid tattooing. OBSERVATIONS: A 63 year old woman presented with left eye redness and irritation 3 days after undergoing permanent eyeliner tattooing of her upper and lower eyelids. On ocular examination a black pigmentation of the nasal cornea in her left eye was observed, with associated conjunctival injection. Initial slit lamp attempts of pigment removal were unsuccessful. A surgical attempt to scrape the pigment in the stroma was only partially successful due to the penetration of pigment particles in between stromal lamellae. Microanalysis spectroscopy was performed on a specimen of pigment taken from the eyelashes in order to attain the chemical properties of the material and assist with further therapeutic strategy. The analysis revealed an organic inert nature of the material (mostly carbon and oxygen) and ruled out presence of dangerous components such as copper and lead. Due to minimal inflammatory reaction and the non-central location of the corneal pigmentation, the patient remained under close observation, treated with lubrication and no further interventions, until complete resolution by 6 weeks. CONCLUSIONS AND IMPORTANCE: While the procedure of cosmetic blepharopigmentation is considered relatively safe, it bares many possible complications, ranging from mild dermal irritation to vision-threatening conditions. Our case of inadvertent keratopigmentation demonstrates the potential dangers of this procedure, and the importance of medical supervision and intervention in cases of complications. Vision preservation in this case was enabled by the midperipheral location of the pigment penetration.

Keratopigmentation with micronised mineral pigments: complications and outcomes in a series of 234 eyes.

AIM: To report the complications observed in a consecutive large series of cases treated with keratopigmentation (KTP). METHODS: KTP was performed in 234 eyes of 204 patients for therapeutic and cosmetic reasons. From them, 50 eyes of 29 patients suffered complications. Different KTP techniques and three generations of pigments (GP) were used. The follow-up period ranged from 4 months to 12 years. Light sensitivity (LS), visual field (VF) limitations and MRI alterations were considered functional complications. Organic complications were described as change in colour, colour fading and neovascularisation. RESULTS: The percentage of complications was 12.82%. Most patients complained of LS (49%), then colour fading and change in colour (19%). Neovascularisation, VF limitations and MRI complications constituted 7%, 4% and 2%, respectively. Organic complications were observed with the previous GP but resolved with the latest third GP with CE mark certification (Conformité Européene). Although LS remained with the corneal-specific pigments, it gradually disappeared in most of the patients (81.81%) 6 months postoperatively. CONCLUSION: To the best of our knowledge this is the first time a study systematically and comprehensively approaches and reports KTP complications. KTP with third GP provides better results and fewer complications than previous ones. It is a modern, minimally invasive technique that helps solve several functional ocular problems and improves cosmetic appearance of the patients. Dermatological pigments should not be used as they lead to complications; instead pigments specifically tested for the eye in terms of toxicity and teratogenicity should be used.

The Safety and Effectiveness of a Novel Annular Keratopigmentation Method: A Case Report.

BACKGROUND: We investigated the safety and effectiveness of a novel aesthetic femtosecond-assisted annular keratopigmentation technique. CASE REPORT: A 21-year-old female patient in good general and ophthalmological health with the wish to change the colour of her eyes was treated with a femtosecond-assisted annular keratopigmentation technique. Pigment was inserted in a channel in the cornea (external diameter 9.3 mm; internal diameter 5.5 mm) created with a femtosecond laser at a depth of 225 µm. Eight months post-operatively, there were no signs of leakage, diffusion, inflammation or any other detrimental effects on the cornea both objectively and subjectively. CONCLUSION: This procedure is a promising safe and effective option for those who want annular keratopigmentation for aesthetic reasons.

Ceratopigmentação (tatuagem corneana): utilização de técnicas combinadas para melhora estética em olhos de pacientes com opacidades corneanas / Keratopigmentation (corneal tattooing): use of combined techniques for aesthetic improvement in eyes of patients with corneal opacities

RESUMO Objetivo: Relatar, por meio de uma série de casos, a percepção de pacientes com opacidade corneana sobre a eficácia da tatuagem na melhoria estética de seus olhos, utilizando a combinação de duas técnicas. Métodos: Oito pacientes responderam a um inquérito sobre sua satisfação estética com o procedimento, o desconforto pós-operatório e o impacto social observado após a cirurgia. Resultados: Todos os pacientes consideraram-se muito satisfeitos com os resultados. Em relação ao grau de desconforto no pós-operatório, 75% disseram ter tido pouco desconforto, e 25% relataram desconforto moderado. Todos os pacientes relataram melhora significativa no bem-estar social e pessoal. Da mesma forma, todos os pacientes disseram que repetiriam o procedimento. Conclusão: A tatuagem corneana surge como um método alternativo às lentes de contato e às próteses oculares em pacientes cegos com leucomas, trazendo resultados estéticos satisfatórios, duradouros e que podem promover impactos sociais na vida desses pacientes.

ABSTRACT Objective: To report, through a case series, the perception of patients about the effectiveness of corneal tattooing in the cosmetic improvement of their eyes with leukomas, using a combination of two techniques. Methods: Eight patients answered a survey regarding their cosmetic appearance satisfaction regarding the procedure, postoperative discomfort, and social impact observed after surgery. Results: All patients considered themselves very satisfied with the cosmetic results. Regarding the degree of postoperative discomfort, 75% said they had little discomfort, while 25% reported moderate discomfort. All patients reported significant improvement in social and personal well-being. Likewise, all patients said they would repeat the procedure. Conclusion: Corneal tattooing appears as an alternative method to contact lenses and ocular prostheses in impaired eyes with leukomas, bringing satisfactory and long-lasting cosmetic improvement that can promote social impacts for these patients.

Personalised lamellar keratoplasty and keratopigmentation in Asian corneal leucoma patients.

OBJECTIVE: To describe a personalised lamellar keratoplasty (LK) associated with the keratopigmentation (KTP) technique for corneal leucoma among Asian patients. METHODS: This report was a non-randomised, retrospective clinical study performed in 32 consecutive eyes of 32 patients to improve cosmetic appearance. Twenty-two patients underwent LK combined with KTP, either by intralamellar or superficial route. Ten patients underwent the single personalised keratopigmentation method. The subjective and objective cosmetic results, ocular irritation, colour fading, neovascularisation formation and incidence of immune rejection were evaluated until three years after surgery. RESULTS: No complications occurred, and the corneal leucoma was successfully stained with India ink in all 32 patients. Most of the patients showed good cosmetic appearance. Pain, conjunctival congestion, corneal edema and foreign body sensation disappeared gradually within two to three weeks after surgery in all patients. Graft swelling, non-healing, or detaching was not observed during follow-up. However, two patients had slight opacity three years after LK. Colour fading was observed in one patient who underwent intralamellar corneal staining 10 months after surgery. Re-staining was performed. CONCLUSION: KTP combined with personalised LK is an effective personalised technique that presents long-standing colour staining and good cosmetic efficacy.

[Surgical intrastromal keratopigmentation using tattoo ink]. / Queratopigmentación quirúrgica intraestromal con tinta para tatuaje cutáneo.

CASE REPORT: A 31-year-old woman who had undergone surgery for a congenital cataract as a newborn developed bilateral malignant glaucoma, which was refractory to medical-surgical treatment. The patient currently has terminal glaucoma and severe band keratopathy. For aesthetic purposes, we performed intrastromal keratopigmentation surgery using ink for skin tattoos supplied in sterile single-dose vessels. No secondary effects or complications were observed. DISCUSSION: Keratopigmentation or corneal tattooing can now be used as a last resort in patients who are unable to tolerate cosmetic contact or intraocular lenses, or in whom corneal transplant is contraindicated.