Corneal Tattoo

Wayne Memorial Hospital
DATE OF PROCEDURE: 4/6/2004
SURGEON: Charles S. Zwerling, MD, FACS, FICS

PRE/POST OPERATIVE DIAGNOSIS:
1. Corneal degeneration right eye.

OPERATION/PROCEDURE:
1. Corneal tattooing and ocular surfacing right eye.

ANESTHESIA: General anesthesia.

COMPLICATIONS: None.

INDICATIONS FOR SURGERY: The patient is a 58-year-old black male who years ago sustained a severe alkali chemical burn to his right eye.This injury has caused continued episodes of re-inflammation of the right eye, symblepheron formation, and recurrent corneal erosions.. The patient most recently has had corneal neovascular changes as a result chronic corneal erosions related to instability of the corneal surface. He has elected to undergo corneal tattooing of the right eye in order to improve the ocular surface as well as provide cosmetic relief. If, however, the corneal tissue is not viable and the patient sustains loss of anterior chamber contents as a result of the corneal punctures and tattooing, the patient has also elected to undergo immediate evisceration of the right eye.

OPERATIVE REPORT: The patient was taken to the main operating room where he was prepped in the usual manner for intraocular surgery. Thepatient was draped in a sterile fashion giving exposure to his right eye. Anesthesia and akinesia was obtained by means of general endotracheal anesthetics.

Then the Jaffe lid retractors were placed into the patient's right eye and using calipers, Picture 1 the optical center of the right eye was determined to be at 6 mm. This area was carefully marked with black Permark tattoo pigment. Then using the 9 needle cluster and Permark rotary tattoo machine, an artificial pupil was created at the optical center of the cornea. The size of this pupil was determined by the contralateral eye, between 3-4 mm in diameter. Picture 2  Then switching to the dark brown Permark pigment and using 0.12 forceps to stabilize the eye, radial pigmentation was now performed in a 360 degree surface. Special attention was applied to the cystic cornealbleb that was located inferior temporally in the mid corneal region. This area was very superficially and very carefully tattooed to avoid corneal perforation. The area of cornea was checked for symmetry and color and additional areas of radial artificial iris was enhanced by means of the black Permark pigment. Picture 3 This created a pleasing effect to the right eye as well as stabilizing the corneal surface. Hemostasis from the corneal neovascularization was achieved by means of pressure, using a soaked balanced salt solution as well as use of topical 4% Cocaine solution and a soaked sponge as well.

At the conclusion of the case, 20 mg of Solu-Medrol and 20 mg of Garamycin and 3 cc of Xylocaine 2% solution were all injected subconjunctivally. Picture 4 The eye was then pressure patched with TobraDex ophthalmic ointment and an ice packed placed over the right eye. The patient tolerated the procedure well and left the operating room in excellent condition.

DISCUSSION: Corneal tattooing has been in the medical literature for over 75 years; however, only recently in the past 10 years have we seen a resurgence in the interest of corneal tattooing as a surgical option for unstable corneal surfaces in patient's with blind eyes. Most patients would prefer keeping their own eyes versus the use of an artificial eye. Moreover the surgical risks of evisceration or enucleation are significant when compared to corneal tattooing. The benefit of corneal puncture in the treatment of recurrent corneal erosions is well documented in the medical literature as well. Therefore, the combined approach of corneal punctures with tattooing is a benefit for certain patients.

Charles S. Zwerling, MD, FACS, FICS, FRCS
2709 Medical Office Place
Goldsboro, NC 27534
919-736-3937