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Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint
  1. Joan D Balgos1,
  2. Maria A Amesty2,
  3. Alejandra E Rodriguez1,
  4. Olena Al-Shymali1,
  5. Sabat Abumustafa3,
  6. Jorge L Alio4,5
  1. 1 Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
  2. 2 Ocular, Plastic, Reconstructive, Lacrimal and Orbital Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
  3. 3 Department of Ophthalmology, Ahmadi Hospital Kuwait, Kuwait City, Kuwait
  4. 4 Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
  5. 5 Department of Ophthalmology, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
  1. Correspondence to Professor Jorge L Alio, Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante 3016, Spain; jlalio{at}


Background Therapeutic corneal pigmentation has modernly evolved into different sophisticated techniques to camouflage cosmetically disabling corneal opacities and scars with good reported outcomes. Blind eyes frequently suffer from strabismus which further deteriorates the cosmesis of the patient. Combined keratopigmentation (KTPG) with strabismus surgery may be an option for these patients.

Methods A total of 72 consecutive patients were retrospectively reviewed in this investigation. Main outcome measures were postoperative residual squint, and cosmesis evaluated by an independent observer, patient satisfaction, reoperation rates for KTPG and squint, and complications.

Results A total of 72 consecutive patients and 73 eyes that underwent KTPG and strabismus surgery were included in this study. Mean follow-up time was 2.5±3 years. Patient age ranged from 5 to 83 years, with 93% having visual acuity worse than 0.1. 14 eyes (24.5%) underwent repeated KTPG, 24 (42.1%) had repeated strabismus surgery. 14 patients (19.4%) had a repeat muscle surgery, although 55 (76.4%) of the 72 patients achieved orthotropia or had deviations within 10 prism dioptres at the end of the follow-up period. Corneal microperforation was encountered in two (2.8%) patients and conjunctival staining in 10 eyes. Cosmesis was good for all patients. Patients who required repeat KTPG or strabismus surgery, or those in whom orthotropia was not totally restored, considered their cosmetic appearance sufficiently improved.

Conclusion Corneal KTPG combined with strabismus surgery provides good cosmesis for patients with corneal scarring and strabismus with minimal complications. Reoperation rates are relatively high in the short term to accomplish an optimal cosmetic result.

  • keratopigmentation
  • strabismus surgery
  • cosmetic therapeutic keratopigmentation
  • functional therapeutic keratopigmentation
  • corneal leukoma
  • oculoplastic surgery
  • squint surgery
  • strabismus

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  • Funding This publication has been carried out in the framework of the Red Temática de Investigación Cooperativa en Salud (RETICS), reference number RD12/0034/0007 and RD16/0008/0012, financed by the Instituto Carlos III – General Subdirection of Networks and Cooperative Investigation Centers (R&D&I National Plan 2008-2011) and the European Regional Development Fund (Fondo Europeo de Desarrollo Regional FEDER).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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