Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

Sang Min Kwon; Hyun Chul Oh; Dong Joon Lee; Woo Chan Park

doi:10.3341/jkos.2009.50.1.151

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Kwon, Oh, Lee, and Park: Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

Original Article

J Korean Ophthalmol Soc 2009;50(1):151-159.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.151

Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

Sang Min Kwon, M.D., Hyun Chul Oh, M.D., Dong Joon Lee, M.D., Woo Chan Park, M.D.

Department of Ophthalmology, Dong-A University College of Medicine, Pusan, Korea

Address reprint requests to Woo Chan Park, MD Department of Ophthalmology, Dong-A University College of Medicine #3-1 Dongdaesin-dong, Seo-gu, Pusan 602-714, South Korea Tel: 82-51-240-5227, Fax: 82-51-254-1987, E-mail: wcpark@dau.ac.kr

Received 21 October 2008 Accepted 2 June 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the effects of corneal tattooing on patients with a traumatic iris defect.

Case Summary

Corneal tattooing operation was performed on three patients (3 cases) with a traumatic iris defect. In case 1, the cornea was dyed with Davidson^® marking dyes (Bradley Products Inc., MN, US) and the amniotic membrane with the central incision was permanently transplanted. In case 2, both corneal dyeing and permanent amniotic membrane transplantation were performed on the area of partial iris loss. In case 3, corneal dyeing was performed after the intrastromal cornea was dissected. Corneal reepithelization was found in the first 2 cases 12 and 9 days after amniotic membrane transplantation, respectively. Three months after the transplantation, all three cases showed an improvement in best corrected visual acuity (BCVA), with an increase of one or more lines on the Snellen Chart. Simultaneously, preoperative monocular contrast and glare were also found to beimproved in all three cases. In both cases 1 and 2, 60% of the initially used dyes still remained in the cornea 6 months after the surgery, and in case 3, 90% of the initial dye remained. Except for the moderate astigmatism found earlier after the surgery in case 3, no serious complications developed.

Conclusions

Corneal tattooing can improve the visual acuity and reduce glare in eyes with a traumatic iris defect and is cosmetically pleasing. Furthermore, corneal tattooing can be performed more easily and repeatedly than black diaphragm intraocular lens implantation.

Keywords: Amniotic membrane transplantation, Corneal tattooing, Davidson®marking dyes, Traumatic iris defect

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Figure 1.

Photograph shows an eye having traumatic aniridia (A). We performed both corneal tattooing and amniotic membrane transplantation with the central incision (B). Corneal reepithelialization was completely achieved on the postoperative second week (C). This shows the well-stained cornea on the postoperative third month, especially in terms of retroillumination (D). (Case 1)

Figure 2.

Photograph shows a partial iris defect on the 6~10 o’clock direction (A). We first performed the transplantation of the already tattooed amniotic membrane (B). Four years later, the tattooed dyes were almost discolored (C). So we performed the second corneal tattooing and then both permanent and temporary amniotic membrane transplantation (D). No epithelial defect was found on the second week after the above second operation (E). This shows that the dyes of corneal tattooing and iris color are well matched with each other (F).(Case 2)

Figure 3.

Photograph shows an eye having traumatic aniridia (A). We performed intrastromal corneal tattooing (B). The state of the tattooed cornea was well-maintained throughout the follow-up observation (C). This Pentacam^Ⓡ Scheimfplug (Oculus inc., Germany) image shows the significant astigmatic eye on the postoperative first week (D). (Case 3)

Figure 4.

These graphs show the test results of contrast sensitivity and glare. All three cases showed an improvement at all four spatial frequencies of cycles per degree (cpd) on the postoperative 3rd month. (Contrast sensitivity was measured with the Standard Version of the CSV-1000E Chart (VectorVision, US) in accordance with applicable standards developed by Boxer and Krueger.¹²

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