{"id":3608,"date":"2023-06-01T12:51:50","date_gmt":"2023-06-01T10:51:50","guid":{"rendered":"https:\/\/www.bluegreenmedical.com\/?p=3608"},"modified":"2023-06-01T12:51:50","modified_gmt":"2023-06-01T10:51:50","slug":"cosmetic-surgery-of-the-cornea-a-new-type-of-surgery","status":"publish","type":"post","link":"https:\/\/www.bluegreenmedical.com\/es\/cosmetic-surgery-of-the-cornea-a-new-type-of-surgery\/","title":{"rendered":"Cosmetic Surgery of the Cornea: A new type of Surgery"},"content":{"rendered":"

By Dr Jorge L. Ali\u00f3<\/strong><\/p>\n

Over the past 1 O years, an increasing number of studies have been conducted on the topic of keratopigmentation-that is, the induced cosmetic pigmentation change in the cornea.<\/strong><\/em><\/p>\n

Keratopigmentation can be done for therapeutic purposes (eg, for cornea! leucomas and blind and disfigured eyes, as well as cases with traumatic aniridia or other problems that affect the eye’s quality of vision).<\/p>\n

The topic has been exten\u00adsively studied and covered in a series of papers that have demonstrated that such techniques are effective, feasible and very useful for patients.<\/p>\n

Following this, the purely cosmetic application of this technique has offered the possibility to change the apparent colour of the eye on a voluntary basis. This is purely an aesthetic applica\u00adtion that has been obviously disruptive and controversia!. My colleagues and I first described this technique, 7 and it has been practised in Eu\u00adrope by a few surgeons on a continua! but selective basis. The biotolerance and local toxicity of the pigments used in keratopigmentation have been the subject of extensive experimental studies. In Figure 1, we display the in\u00adstruments used in the modern keratopigmentation surgical technique.<\/p>\n

Therapeutic keratopig\u00admentation is indeed a new and relevant type of cornea!<\/p>\n

surge1y; however, it is still not in general use, essentially because of the insuffi.cient development of pigments specifically for cornea! use. Patients with disfigured corneas and blind eyes, and patients who prefer not to go through the trauma associ\u00adated with evisceration and enucleation and their poten\u00adtial complications, find this new type of surge1y to be a very valuable alternative that can successfully restore their appearance in a less invasive manner.<\/p>\n

The pigment may be placed inside the cornea! stroma when the superficial cornea is transparent (intra\u00adstromal keratopigmentation) (Figure 2). With totally opaque corneas, the tech\u00adnique should be performed by applying the pigment on the cornea! surface (superfi\u00adcial keratopigmentation)
\n(Figure 3). either manually or using an automatic device (Figure 4). In superficial keratopigmentation, the pigment is injected into the superficial cornea] stroma up to the leve] of 140 \u00b5m, after denuding the come! epitheli\u00adum (Figure 3).<\/p>\n

Superficial leucomas are treated with superficial techniques, whereas deep opacities, aniridias and other problems that happen in a patient’s eye are better treated by intralamellar techniques. Sur\u00adgical instruments and techniques have also been described in detail in other publications.15 (Figures 1 and4).
\nWhen the superficial cornea! stroma is transparent, the intras\u00adtromal pigmentation technique can be better used. For this purpose, cornea! stromal tunnels are created, assisted by femtosecond laser at the adequate cornea! depth, which also creates a dissection to simulate the pupil at an adequate diameter (Figure 2).<\/p>\n

Such cornea! tunnels may also be created manually using adequately designed instruments (Figures 1 and 2).<\/p>\n

\"\"<\/p>\n

 <\/p>\n

The pigment is matched to the colour of the contralateral normal eye, while the pupil is simulated with black pigment (Figure 5). The main limitation of this technique is the availability of pigments, which are, as of the writing of this article, lirnited to a few colours and labeled for cornea! use with the CE mark. The use of dermatological pigments probably could be acceptable, but the lack of negative effects has not yet been demonstrated on the normal or diseased cornea, as the pigments are made of compounds that are often reactive when in con\u00adtact with light; thus oxidation may occur. This can lead to a change in the colour over time and might make outcomes of this surgery unpredictable.<\/p>\n

Frequently, severely compro\u00admised and blind eyes are associated with other disfiguring features such as squint and ptosis, which can also be successfully corrected at the same time as the keratopigmen\u00adtation procedure is performed. A high level of patient satisfaction has been reported with the use of such combined surgical techniques (Figure 6).<\/p>\n

\"\"<\/p>\n

Functional disabilities are caused by iris problems such as aniridia, iris atrophy and iris colobomas. Sorne o\u00ed these cases, which either currently have no solution or require extensive and invasive sur\u00adgeries, may be approached today with intrastromal keratopigmenta\u00adtion. Even intractable diplop\u00edas can be solved with keratopigmentation creating a central scotoma by the creation of a sirnulated pupil o\u00ed adequate diameter.<\/p>\n

Controversial topic<\/h3>\n

The purely cosmetic use o\u00ed kera\u00adtopigmentation is disruptive and controversial because o\u00ed the vol\u00aduntary change of colour o\u00ed the eye that intrinsically has this problem. The procedure is elective, can be performed inadequately and can lead to complications in normal eyes. With respect to this fact, find\u00adings from a recent study demon\u00adstrated that keratopigmentation is, undoubtedly, the best option available for those individuals who wish to change the apparent colour o\u00ed the eye on a voluntary basis. It demonstrates superior sa\u00edety to and better outcomes than the altema\u00adtive approaches using iris colour prosthesis or laser iris depigmenta\u00adtion procedures, which are affected by myriad severe complications that can lead to severe visual loss and even blindness. In particu\u00adlar, the use o\u00ed prosthetic coloured irises should be considered today as a medical malpractice proce\u00addure beca use of the proven severe comorbidities that have been demonstrated to be induced by their implantation in the medium and the long term.<\/p>\n

 <\/p>\n

Emerging surgical technique<\/h3>\n

With this in mind, it should be considered that this emerging surgical technique o\u00ed keratopig\u00admentation has been refined with the modem development of specific surgical instruments. These include \u00edemtosecond lasers and the modem development o\u00ed pigments. However, the comeal pigments used are considered underdeveloped owing to the main limitation o\u00ed this technique to be used in general.<\/p>\n

Thus, this technique is open to future developments that will be extremely attractive for ophthal\u00admologists, comeal specialists and cosmetic surgeons. It will also be attractive for patients affected by morbidities that affect the cosmet\u00adics o\u00ed their eyes due to disfiguring comeal leucomas. The procedure will also appeal to patients who desire to change their appearance through the colour o\u00ed their eyes, which should be done for good reason and with appropriate selec\u00adtion by their surgeons.<\/p>\n

A new comeal surgical per\u00adspective is now available with a good level o\u00ed published evidence in support. I envision a promising future that will follow this group o\u00ed new surgical techniques. This topic will probably progress immensely in the coming years along with the increase in clinician experience and the development o\u00ed more appropriate, specific and diverse comeal pigments. l<\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr Jorge L. Ali\u00f3 Over the past 1 O years, an increasing number of studies have been conducted on […]<\/a><\/p>\n","protected":false},"author":140,"featured_media":3609,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_glsr_average":0,"_glsr_ranking":0,"_glsr_reviews":0,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3608","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/posts\/3608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/users\/140"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/comments?post=3608"}],"version-history":[{"count":0,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/posts\/3608\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/media\/3609"}],"wp:attachment":[{"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/media?parent=3608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/categories?post=3608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bluegreenmedical.com\/es\/wp-json\/wp\/v2\/tags?post=3608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}