Abstract
Introduction Keratopigmentation was first documented almost 2000 years ago, using reduced copper sulphate to mask a corneal leucoma. Over time, copper was replaced with metallic powders, allogeneic uveal pigment and both Indian and Chinese ink.
Aims Keratopigmentation was used to improve cosmetic appearance and sight and decrease light scattering and glare.
Methods A 73-year-old man was referred to the corneal clinic with ongoing glare, intermittent monocular diplopia and photophobia after a complex phacoemulsification which left an iris defect at the 9 o’clock position.
Seven months after cataract surgery, visual acuity was 6/9 bilaterally, with an IOP of 14mmHg in the affected eye.
After discussion regarding the risks and benefits (failure-no symptomatic improvement, visual field loss, loss of visual acuity, corneal decompensation, further surgery (including iris prosthesis), colour change/fading, neovascularisation the patient consent and wished to be listed for corneal tattooing.
The procedure was performed in the Ophthalmic Theatre Suite. Kandahar ink was used as has fewer incidences of reaction due to its composition.
An intrastromal technique was used to aid ink distribution and stability.
The patient was given some steroids and antibiotic drops to use after the surgery.
Results The patient was reviewed four weeks later and reported that glare symptoms had settled. After 10 weeks the corneal suture was removed.
His glare had improved further, with corrected visual acuity 6/6 with pinhole.
Conclusion Keratopigmentation is an effective way of managing the resultant glare and photophobia, improving quality of life. It represents a simple, low risk alternative for many other indications besides iris trauma.
