Therapeutic Keratopigmentation: Cosmetic and Functional Outcomes

Seyed Javad Hashemian; Sepehr Roozdar; Jorge L Alió

doi:10.1007/s40123-025-01131-0

Therapeutic Keratopigmentation: Cosmetic and Functional Outcomes

Ophthalmol Ther. 2025 May;14(5):1133-1145. doi: 10.1007/s40123-025-01131-0. Epub 2025 Apr 3.

Authors

Seyed Javad Hashemian¹, Sepehr Roozdar¹, Jorge L Alió^{2

3}

Affiliations

¹ Eye Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran.
² Vissum Miranza, Alicante, Spain. jlalio@vissum.com.
³ Miguel Hernandez University, Alicante, Spain. jlalio@vissum.com.

Abstract

Introduction: This work aimed to assess the safety and outcomes of femtosecond laser-assisted intrastromal keratopigmentation (FIK) and superficial automated keratopigmentation (SAK) using micronized mineral pigments (MMPs) as a therapeutic cosmetic tool.

Methods: Keratopigmentation (KTP) was performed in 85 eyes of 85 patients with moderate-to-severe cosmetic disabilities (20/80 to no light perception) related to various etiologies causing corneal scarring or iris abnormalities. Thirty-six eyes were treated by FIK, 46 eyes by SAK, and three eyes using combined SAK + FIK. The cosmetic outcome, patient satisfaction, and occurrence of any related complications were recorded. The cosmetic or visual outcome was assessed through patient-reported feedback, while an independent observer evaluated the cosmetic appearance at the 6th month postoperatively. The mean follow-up period was 13.06 ± 9.9 months (6-53 months).

Results: The study included 48 males and 37 females. The mean age was 37.8 ± 14.25 (14-77 years). An independent observer assessed the cosmetic outcome as excellent or good in 91.8% of cases. Excellent or good cosmetic outcome was reported by the independent observer in 91.4% of the SAK group, 91.5% of the FIK group, and 100% of SAK + FIK combined. Eighty percent of patients reported cosmetic satisfaction 3 weeks postoperative; 73.9% of SAK group, 86% of FIK group, and 100% of the combined SAK + FIK group were satisfied with their cosmetic outcome. Twelve eyes of SAK and five eyes of FIK group required additional KTP procedures because of color fading and cosmetic unsatisfaction. Post-operative symptoms were photophobia (28.2%), tearing (23.5%), and pain (8.2%). Post-operative complications were dry eye (5.8%), delayed epithelial healing (2.3%), and microbial keratitis (1.1%).

Conclusions: This study confirms that FIK and SAK using micronized mineral pigments are safe and efficient surgical techniques for managing cosmetic and visual disabilities caused by iris abnormalities and cosmetic issues related to corneal scars.

Keywords: Corneal scar; Corneal tattoo; Femtosecond laser; Iris defect; Keratopigmentation; Micronized mineral pigments; Reconstructive eye surgery.