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Chemical Corneal Tattooing According to Knapp using Excimer Laser Keratectomy: Report of 3 Cases

Sekundo W.,
Philipps-Universität Marburg, Medizinisches Zentrum für Augenheilkunde (Marburg)

Purpose: Corneal tattooing with PtCl was described by Knapp over a century ago. An indication for such a cosmetic operation has significantly decreased due to advances in microsurgery and manufacturing if iris print contact lenses. Thus, when such a surgery is anticipated, one usually deals with severely altered corneal tissue. We report on our 1 year experience in 3 cases, where a superficial keratectomy was done by an excimer laser. 
Method: All 3 eyes were blind secondary to old perforating injuries, partially followed by failed vitreoretinal repair surgery and intolerant to contact lenses. In the first case silicone keratopathy was present. In the second case, a phthitic eye developed band kerathopathy and white mature cataract. A third case also presented with scarred and vascularized cornea. Initially, the corneal center was marked and the globe fixated by a special suction ring, which can be recognized and engaged by the MEL-70 excimer laser eyetracker (Asclepion Meditec/Germany). Transepithelial keratectomy of 50-80 µm was performed in accordance with the underlying condition. Thereafter a traditional tattooing was carried out using PtCl and hydralazine.
Results: A cosmetically appealing pseudopupil was created in all cases, however the eye with severe pannus vasculosus shows some discoloration at the 12 o’clock position, currently covered by the upper eye lid.
Conclusions: MEL-70 Ring-Eye-Tracker technology enables a fast, precise and atraumatic Excimer laser keratectomy in corneal tattoing.