Corneal Tattooing to Treat Glare Symptoms Following Radial Keratotomy

Abstract

Radial keratotomy (RK) may be complicated by postoperative glare and night vision may be compromised when parts of RK incisions fall within the boundary of the dilated pupil. Surgical pigmentation of the cornea has been used to treat glare symptoms caused by corneal trauma and iris loss. In this study, corneal tattooing was performed in a patient who had undergone 16-incision RK and 6-incision astigmatic keratotomy (AK) elsewhere. With one eye covered, the patient in this study was shown a white spot projected onto a visual acuity screen and asked to draw the image on a Night Vision Recording chart before and after tattooing. Sterile iron oxide powder was suspended in sterile saline to approximate the patient’s iris color. Using a 69 Beaver blade, Sinskey hook, and 30-gauge needle, the wounds were reopened and pigment deposited. The procedure was repeated twice. The patient studied reported marked decrease in glare symptoms following tattooing. Postoperative drawings of the projected spot image showed significant regression of halation. Focal areas of pigment dispersion required retreatment, which improved symptoms to a lesser degree. From this result it is concluded that tattooing procedures can be used to pigment radial keratotomy scars in patients who complain of glare. The material best suited for this purpose has yet to be determined. Iron oxide suspensions have been successful, though pigment migration out of the scars seems to have contributed to recurrence of symptoms.