A Case of Alternaria Species Infection after Corneal Tattooing

PURPOSE: To report a case of successful treatment of Alternaria species infection after corneal tattooing using penetrating keratoplasty corneal perforation. CASE SUMMARY: A 65-year-old male underwent corneal tattooing for corneal opacity of the left eye. One month later, epithelial defect and necrosis of the left eye were observed, thus a smear and culture were performed and Alternaria species were cultured. He was treated with 0.3% amphotericin B-fortified eyedrops and Itraconazole oral medication; however, 3 weeks later, corneal perforation of the left eye was observed and penetrating keratoplasty was performed. Postoperatively, due to persistent increased intraocular pressure, trabeculectomy was performed. Two months later, donor cornea was well-grafted and recurrent keratitis was not observed. CONCLUSIONS: Corneal tattooing can cause damage to the corneal epithelium and anterior stroma and increase the risk of infection when using steroids. In the case of infection, detecting and differentiating the type of microorganisms are more difficult. Therefore, proper care and close monitoring for the signs of infection are important during and after the surgery.

Two Cases of Glare after Iridotomy for Phakic Intraocular Lens Implantation

PURPOSE: The present study is a case report of 2 patients (4 eyes) whose symptoms subsided after corneal tattooing over the iridotomy site for persistent and excessive glare, which developed after iridotomy for phakic intraocular lens implantation. CASE SUMMARY: Two patients developed excessive glare symptoms after receiving iridotomy as a pre-procedure for phakic intraocular lens implantation. Case 1 and Case 2 showed persistent glare symptoms over a period of 6 months. Corneal tattooing was performed on the patients by applying tissue dye to the corneal stroma over the iridotomy site. The symptom was evaluated by comparison of glare scores from 0 to 10 after the procedure with a score of 10 prior to the procedure. After corneal tattooing, patient 1 reported a score of 4 and patient 2 reported a score of 3, showing significant symptom improvements without additional complications. CONCLUSIONS: Corneal tattooing at the peripheral cornea in front of the iridotomy site for patients with persistent glare symptoms after prophylactic iridotomy was shown to be effective.

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

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(R) 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.

7 Cases of Combined Corneal Tattooing and Amniotic Membrane Transplantation in Bullous Keratopathy

PURPOSE: We report on the clinical efficacy of the combined operation of corneal tattooing and amniotic membrane transplantation on the treatment of bullous keratopathy in patients with poor visual potentials. CASE SUMMARY: We performed corneal tattooing and amniotic membrane transplantation in 7 eyes with bullous keratopathy. Postoperatively, we assessed the status of corneal reepithelialization, postoperative pain, and cosmetic effects. In all cases but one, corneal reepithelialization was successful without pain, and the corneal tattooing persisted throughout the follow-up period. In one case, a corneal epithelial defect developed, so we performed an additional amniotic membrane transplantation. After 2 weeks, the corneal epithelial defect healed and caused no further pain. CONCLUSIONS: The combined operation of corneal tattooing and amniotic membrane transplantation is a good choice for the treatment of bullous keratopathy with regard to cosmetic problems, pain, and poor visual potential.

Changes of Corneal Nerve Regeneration and Corneal Sensitivity after Corneal Tattooing

PURPOSE: To investigate the changes of corneal nerve innervation and sensitivity after corneal tattooing. METHODS: Twelve New Zealand rabbits were divided into two groups of six subjects each. Tissue marking dye or balanced-salt solution was injected into the corneal stroma in one eye of each subject. Corneal nerve innervation was observed at 3 days and 1, 2, 3, 4, and 6 weeks postoperatively and compared with that of the opposite eyes. Corneal sensitivity was evaluated at 1, 2, and 3 days and 1, 2, 3, 4, and 6 weeks postoperatively and compared to the preoperative values in the same subjects. RESULTS: The ratios of corneal nerve density of the study eyes to those of the control fellow eyes were 1.09 in the central area and 1.06 in the peripheral area in subjects injected with tissue marking dye, and 1.11 and 1.23, respectively, in subjects injected with balanced salt solution, which showed no difference between the two groups. The corneal nerve density tends to increase at 3 days postoperatively (p=0.125), but no significant change was found thereafter. Corneal sensitivity assessed using the Cochet-Bonnet esthesiometer was 2.13+/-0.48 cm preoperatively. At three days postoperatively, it was 2.50+/-0.48 cm in subjects injected with tissue marking dye and 2.33+/-0.26 cm in subjects injected with balanced salt solution. It was significantly increased at 3 days postoperatively (2.42+/-0.36 cm, p=0.031), but there were no significant changes at 7 days or more postoperatively. CONCLUSIONS: Corneal nerve density increased at 3 days after corneal tattooing, and this effect is thought to be related to early postoperative hypersensitivity.

Two Cases of Cosmetic Treatment of Limbal Dermoid

PURPOSE: To report two cases of cosmetic treatment of limbal dermoid, which consist of local excision of the limbal dermoid, corneal tattooing, and amniotic membrane transplantation. METHODS: Dermoid excision, corneal tattooing, and amniotic membrane transplantation were carried out in both a girl and a woman who each had a limbal dermoid in their left eyes. Postoperatively, they were followed up for more than six months. RESULTS: No specific complications occurred. The patients were satisfied with the surgical results. After a few months the conjunctiva was found to grow into the tattooed cornea. CONCLUSIONS: In the treatment of limbal dermoid, local excision combined with corneal tattooing and amniotic membrane transplantation can be a cosmetically successful alternative choice.

Cosmetic Repair of Band Keratopathy Using Stained Amniotic Membrane

PURPOSE: To evaluate the efficacy of stained amniotic membrane transplantation (AMT) for cosmetic repair of band keratopathy. METHODS: Eight eyes from 8 patients with band keratopathy without the possibility of visual improvement were treated with corneal tattooing and stained AMT. Calcific plaques were removed with EDTA and a blade prior to the tattooing. Tattooing by the injection of tissue marking dye into the corneal stroma was performed in corneal opacities. The remaining opacity, which could not be treated with corneal tattooing, was treated with black dye-stained AMT. RESULTS: The most common cause of band keratopathy was trauma (50%) and the mean time to epithelial healing was 11.3 days. All patients showed satisfactory results with cosmetic staining. Recurring cases and significant complications were not observed during the mean follow-up period of 7.4 months. CONCLUSIONS: Cosmetic repair by corneal tattooing and stained AMT is an effective treatment for band keratopathy and is not associated with any significant complications.

Corneal Tattooing to Mask the Opacification after Amniotic Membrane Grafting for Corneal Ulcer

PURPOSE: To report on the cosmetic efficacy of corneal tattooing using India ink in cases where amniotic membrane grafting was performed to promote corneal wound healing in corneal ulcers. METHODS: Amniotic membrane grafting of corneal ulcers was carried out in three patients with no expectation of visual recovery. After corneal reepithelization, a 30 G needle filled with India ink was placed into the amniotic membrane space between the regenerated corneal epithelium and the stromal bed, and the ink was then carefully injected. RESULTS: The staining of corneas to the appropriate opacity with India ink was successful in all cases. There were no significant complications during the mean follow up period of 17 months. All the patients were well satisfied with the corneal staining. CONCLUSIONS: When corneal opacity occurs subsequent to an amniotic membrane graft for a corneal ulcer, this corneal tattooing with an intrastromal injection of India ink into the amniotic membrane space might be a very useful method to achieve a good cosmetic result.