Corneal Ectasia Following Cosmetic Keratopigmentation

The purpose of this study was to describe 5 cases (10 eyes) that, following purely cosmetic femtosecond laser-assisted keratopigmentation (KTP), showed evolution toward corneal ectasia during a variable postoperative period.

In a case series, 5 patients after bilateral purely cosmetic KTP showed progressive changes in topographic, refractive, and even in visual performance values manifesting from 6 months to 4 years following the procedure. A femtosecond laser-assisted cosmetic intrastromal KTP technique was performed in all patients using micronized mineral pigments. Two patients underwent a retouch using superficial automated KTP to optimize cosmetic outcome.

All patients preoperatively demonstrated normal corneal topography with no intraocular pathology and unimpaired visual acuity. One of the cases developed corneal ectasia after magnetic resonance imaging, another confirmed intensive eye rubbing due to allergic conjunctivitis, and 1 patient underwent previous myopic laser in situ keratomileusis procedure. The rest did not show any preoperative clinical evidence potentially related to the development of the keratectasia. One case rather demonstrated modification of keratometry (K) values than a clear corneal ectasia. Three cases were treated with epi-off corneal cross-linking.

Corneal ectasia is a potential complication after cosmetic KTP and should be included in the preoperative informed consent. A comprehensive preoperative screening is necessary to exclude suspicious cases, and patients should be instructed to avoid eye rubbing and other maneuvers that could affect the potential development of this complication.