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Novel Lamellar, Flap-Based Tattooing Techniques for Corneal Opacities in Scarred and Vascularized Blind Eyes

Hos, Deniz MD; Heindl, Ludwig M. MD, PhD; Bucher, Franziska MD; Cursiefen, Claus MD, PhD

doi: 10.1097/ICO.0000000000000259
Clinical Science

Purpose: The aim of this study was to describe novel, flap-based tattooing techniques for the treatment of disfiguring corneal scars in blind eyes.

Methods: Several new modifications of intrastromal corneal tattooing techniques were performed in 6 patients. In corneas with a low risk of perforation, a large limbus-to-limbus lamellar flap was prepared, and the tattooing dyes were spread over the entire stromal bed. After additional puncturing of the dyes into the stroma, the flap was closed and sutured (“large flap technique”). In fragile corneas where convenient preparation of a large flap was not possible, a central small flap was prepared, and the “pupil” was tattooed in analogy (“small flap technique”). Afterward, the corneal periphery corresponding to the “iris” was tattooed, either by puncturing or injecting the dye into peripheral intrastromal tunnels (“tunnel technique”).

Results: Two eyes were tattooed using a large flap, and 4 eyes were tattooed using a small flap. Here, the corneal periphery of 3 eyes was tattooed by puncturing, whereas 1 eye was tattooed using the tunnel technique. All tattooing procedures were performed without complications and with good cosmetic results.

Conclusions: These novel, flap-based tattooing techniques are alternatives to previously reported procedures and can be adapted to the individual corneal constitution. Further, the tunnel technique is an easy-to-perform method that provides good tattooing results.

Department of Ophthalmology, University of Cologne, Cologne, Germany.

Reprints: Deniz Hos, MD, Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany (e-mail:

Supported by German Research Foundation, DFG Cu 47/4-1 (C.C.), DFG Cu 47/6-1 (C.C.), DFG HE 6743/2-1 (L.M.H.); GEROK-Programme, University of Cologne (D.H., L.M.H., and F.B.); and EU COST BM1302 (D.H. and C.C.).

The authors have no conflicts of interest to disclose.

Received June 24, 2014

Received in revised form July 30, 2014

Accepted July 30, 2014

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