Cosmetic Keratopigmentation in Sighted Eyes: Medium- and Long-term Clinical Evaluation

To assess the medium- and long-term outcomes of keratopigmentation (KTP) as a surgical alternative to change the cosmetic appearance of healthy eyes.

A prospective, interventional, consecutive, multicenter, series of cases of cosmetic KTP was included in the study. Forty consecutive patients underwent KTPs with mineral micronized pigments using a femtosecond laser-assisted intrastromal or superficial technique. Main outcomes were cosmetic evaluation, subjective patients' satisfaction, and complications. The outcomes were evaluated at 6 months after the last operation and then yearly.

This study included 79 eyes of 40 patients, with a mean age of 34 ± 11 years; femtosecond laser-assisted intrastromal keratopigmentation was performed in 39 patients (97.5%) and superficial automated keratopigmentation in 1 patient. Mean follow-up was 29 months (range 6-69). Observer's evaluation was excellent in 90% of cases, and patient's satisfaction was excellent in 92.5% of cases. Twenty-eight eyes (35.4%) were reoperated; of them, 7 eyes (8.9%) had 2 color touch ups and 4 eyes (5.1%) had 3 color touch ups. After the retreatments, all the patients were satisfied with the cosmetic aspect. Light sensitivity at first month was the most common complication (30%), followed by change in the color (7.5%), color fading (5%), and visual field limitations in a case with 4.5-mm pupil size (2.5%). One patient with a previous laser in situ keratomileusis developed corneal ectasia.

Cosmetic KTP achieves good cosmetic results and is associated with high patient satisfaction. Most of the complications could be managed adequately. It might offer a safe and effective new surgical alternative for those patients motivated to change the apparent color of their eyes.