Femtosecond laser-assisted keratopigmentation outcomes for pure cosmetic purposes

To assess the visual performance and complications of Femtosecond laser-assisted keratopigmentation for pure cosmetic purposes in a large consecutive series of cases.

This prospective study included 166 eyes that underwent pure keratopigmentation between 2021 and 2023 by one expert surgeon. Demographic data, preoperative examination findings, postoperative outcomes, and complications were collected and analyzed. Data were collected on preoperative and postoperative visual acuity, refraction, intraocular pressure, light sensitivity, endothelial cell count, visual field, and aberrometry. Preoperative and postoperative values were compared to determine any changes. There was no statistically significant difference (p > 0.05) in visual acuity, Mean deviation(MD) and IOP at 12 months after surgery. The presence of horizontal and vertical coma and trefoil aberrations, as well as spherical and HOA (Higher Order Aberration) errors, does not have statistically significant meaning. The mean endothelial cell count decreased from 2393.29 ± 123.69 cells/mm^2 preoperatively to 2308.58 ± 126.64 cells/mm^2 postoperatively. The contrast sensitivity has decreased across all spatial frequencies for mesopic conditions, and the decreases at 1.5 Cycles Pre Degree (CPD) and 18 CPD for photopic conditions were statistically significant. However, it still remains within the normal range.

Pure cosmetic keratopigmentation seems to be a safe and effective surgical technique for improving the cosmetic appearance of the eyes. The technique showed no significant impact on visual acuity, intraocular pressure, visual field. However, slight decreases in contrast sensitivity and endothelial cell count were observed, which should be considered when discussing potential risks and benefits with patients.