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Keratopigmentation: techniques and results
  1. Virgilio Galvis,
  2. Alejandro Tello
  1. Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Universidad Autónoma de Bucaramanga, Floridablanca, Santander, Colombia
  1. Correspondence to Dr Alejandro Tello, Centro Oftalmológico Virgilio Galvis, Centro Médico Ardila Lülle, Torre A, Piso 3, Módulo 7. Floridablanca, Santander, Colombia; alejandrotello{at}

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We read with great interest the article on keratopigmentation by Alio et al, and the letter on the subject by Segal et al. 1 ,2 Corneal tattooing under a lamellar pocket was described more than 25 years ago, but the manual technique described by Alio et al seems to be easier, and when using a femtosecond laser, it is even more surgeon-friendly.3 They published very good results that are undoubtedly related to their adequate technique, but also may be related to the nature of the dye (mineral micronised pigments). They had previously reported that, experimentally, this kind of dye showed no signs of pigment diffusion and practically no signs of inflammation.4 They also reported good results in 40 patients in whom keratopigmentation was performed with cosmetic purposes.5 We have some comments about their recent publication1: in table 1 it is not indicated what notation was used to measure visual acuity and if this value corresponds to best corrected visual acuity. It would be clearer to indicate the average and range of actual follow-up duration instead of indicating a planned period of 1 year.

What do the authors consider as the difference between partial traumatic aniridia and traumatic coloboma?

In the text, it is indicated that no patient lost any line of visual acuity, but patient 2 passed from 1.0 to 0.8 which is one line loss.

It is stated that in all cases it was possible to explore the peripheral retina. With a 4 mm pupil, it is technically very difficult (if not impossible) to evaluate far anterior areas of the retina.

In figure 3, it seems that the patient had some kind of iris surgery, not mentioned, because some folds are evident in the pupil margin (sutures?). It seems unlikely that a patient with that kind of trauma may retain a phakic intraocular lens (IOL) in the anterior chamber. Is the patient phakic or aphakic? Does the IOL correspond to an angle-supported (Kelman type) IOL or an Artisan for aphakia?

In the letter on the subject by Segal et al, they used commercially available sterilised black pigment to cover iridotomies that caused symptoms.2 In figure 2A,B it is evident that it diffused beyond the limbus and that it does not match the colour of the iris. Three out of five patients (66%) had just a mild amount of improvement, and one patient lost the effect of the pigment within months. It seems to us that these results are not satisfactory and that may be related to two factors: performance of the dye is not adequate and the surgical technique has flaws (an incision close to the limbus that makes possible dye diffusion beyond the limbus and too small area of keratopigmentation, which was not large enough to avoid light entering the eye through the iridotomy).


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  • Linked article 301838.

  • Funding None.

  • Competing interests None.

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

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