Disclosures: The authors report no relevant financial disclosures.
June 08, 2021
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Cosmetic keratopigmentation shows long-term efficacy, satisfaction

Disclosures: The authors report no relevant financial disclosures.
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Cosmetic keratopigmentation showed efficacy and high patient satisfaction in a large prospective series of patients with a follow-up of 1 to 6 years.

Previous LASIK surgery was identified as a risk factor and should be included among exclusion criteria.

“Purely cosmetic [keratopigmentation] is a novel indication, on which we have published the results of a first pilot study in 2016. Our experience over many years shows that it is a better and safer alternative to cosmetic contact lenses and iris implants for patients who wish to change the color of their eyes,” study author Jorge L. Alió, MD, PhD, told Healio/OSN.

The study included 79 eyes of 40 consecutive patients aged between 21 and 63 years, operated by Alió. All procedures but one were performed using a femtosecond laser-assisted intrastromal technique, in which pigments are injected in the cornea within a circular lamellar pocket. In one case, pigments were applied using a micropuncture device. Third-generation customized mineral micronized pigments were used to achieve the desired color. Topical antibiotics and steroids were prescribed for 2 weeks following the treatment.

While 51 eyes (64.6%) achieved the desired outcomes with just one intervention, 28 eyes (35.4%) required a color touch-up. Observer evaluation was “excellent” in 90% of the cases, and patient satisfaction was “excellent” in 92.5% of the cases. All patients said they would repeat the procedure.

Light sensitivity over the first month after treatment was reported by 30% of the patients and was absent in patients treated with a deeper stromal pocket. Color change or fading occurred in five patients, who underwent re-treatment. One patient who had previous LASIK surgery developed bilateral progressive corneal ectasia, successfully halted with corneal cross-linking.

“We were able to demonstrate that our keratopigmentation technique is safe and effective. Not only can it address therapeutic-cosmetic and therapeutic-functional problems, but it can also be used for purely cosmetic cases with good outcomes as long as the pigments are properly selected and the surgery is performed with adequate surgical guidance. In my opinion, this is the beginning of a new type of surgery that will be performed much more frequently in the future even though it will obviously be controversial,” Alió said.

Further studies are currently being performed to enhance the biocompatibility, quality and stability of the micronized mineral pigments used in this surgery.

“We need to develop pigments that are inert and not affected by redox reactions, something that happens to some of the molecules that are in use today,” Alió said.