Preoperative examination revealed bilateral normal eyes with no history of surgery or trauma, with visual acuity of 1.0 for both eyes.

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Femtosecond assisted keratopigmentation

First visit postoperatively: patient did not express any symptoms or decrease of vision, and was satisfied with the results as cosmetic appearance change, on cosmetic evaluation: surgeon found colour is too light, cause an artificial look for that he decided to do some colour modifications to give it a more natural look.

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Second surgical retouch:
Superficial Keratopigmentation technique
Black pigment 280 was used for retouching borders of pupil and limbus and a personalized grey blue with a ting of orange was used to modify the iris colour for a more natural colour.

On one year follow up: pigmentation pattern was stable with high patient satisfaction with of the more natural look.

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Patient was started on therapeutic contact lens, with very poor tolerance and developed tarsal papillae with nasal neovascularization. Case gradually progressed to total loss of temporal iris sector.

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Femtosecond assisted keratopigmentation

Tunnel depth of 250 microns with an inner diameter of 4mm and outer diameter of 9.5 mm

First visit postoperatively: patient expressed minimal tearing and photophobia with no hyperaemia and visual acuity slightly decreased to 0.86. The eye had very good cosmetic appearance except for some defects that were presented as areas of transillumination. Surgeon decided to do an enhancement of these defective areas.

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Second Surgical enhancement was through a deeper tunnel of 360 microns with 360 degrees dissection using black 11D26 pigment, as brown on a black back ground would create a superior cosmetic outcome

On 3 months follow up: Patient was very satisfied with both the cosmetic and visual results.

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Several trial of refractive correction and prisms to improve the condition, none of them improved the symptoms, for that the patient had requested a more permanent solution, for which he was advised of the application of functional keratopigmentation to the right eye for the limitation of the visual symptoms.

Manual intrastromal keratopigmentation technique

Using the VISSUM intrastromal micropigmentation system dissectors to fashion a 4 mm pupil and using brown pigment.

First visit postoperatively: patient expressed satisfaction with the relief of the visual disability symptoms with no pain or any other complications . Cosmetic evaluation showed a very good pupil profile.

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On 6 months follow up: Patient was still satisfied with his results, and the cosmetic evaluation showed pigment slightly blurred at the edges due to peripheral pigment dispersion, with slight stromal corneal opacity, but with stable pupil diameter in high, medium and low mesopic conditions. Because of the patient´s satisfaction with the visual symptoms improvements’ , the surgeon chose not to perform further enhancement of the pupil profile.

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On examination left eye presented with sectorial lower temporal iris atrophy with traumatic anterior subcapsular cataract with visual acuity of 0.9 .

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Manual intrastromal keratopigmentation

Using the VISSUM micropigmentation dissectors with brown pigment.

First visit postoperatively: Excellent aspect with stable cataract, patient was highly satisfied with cosmetic appearance and the improve inn visual symptoms.

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On 6 months follow up: Stable pigmentation, and on cosmetic evaluation, surgeon considered reducing the colour saturation for a more natural look.

On one year follow up: Patient satisfied with results and expressed complete relief of visual symptoms.

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