Year : 1984 | Volume
: 32 | Issue : 5 | Page : 408--411
Corneal tattooing-experiences with "lamellar pocket procedure"
A Panda, M Mohan, S Chawdhary
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AJIMS, Ansari Nagar, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS. Ansari Nagar, New Delhi 110029.
|How to cite this article:|
Panda A, Mohan M, Chawdhary S. Corneal tattooing-experiences with "lamellar pocket procedure".Indian J Ophthalmol 1984;32:408-411
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Panda A, Mohan M, Chawdhary S. Corneal tattooing-experiences with "lamellar pocket procedure". Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 18 ];32:408-411
Available from: https://www.ijo.in/text.asp?1984/32/5/408/27524
Corneal tattooing is considered an obsolete procedure by western ophthalmologists. In Indian situation however, the acute shortage of donor cornea coupled with a large number of cases who can benefit visually from keratoplasty, largely restricts corneal transplantation for purely visual propose. Cosmetic contact lenses are- also un suitable for majority of cases owing to poor tolerance due to dusty surroundings and high cost etc. Hence tattooing of corneal opacities still has a role in cosmetic improvement in cases with unsightly corneal scars especially in the women of marriable age group.
To avoid the problems of standard procedure of tattooing, we have performed tattooing under a lamellar pocket and compared it with tattooing done by conventional methods.
MATERIAL AND METHODS
Patients were selected for the study from the Eye Bank Clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi. Only those cases were taken where there wa,, no hope of visual recovery, even after a successful grafting, owing to dense amblyopia, squint or posterior segment disease and the opacity was dense enough to cause a cosmetic blemish [Figure 1].
In group A, (10 eyes) tattooing was done by 2% gold chloride and 1% hydrazine hydrate after debridement of corneal epithelium with 70% alcohol. In group B, (10 eyes) the depth of corneal opacity was carefully assessed by biomicroscopy and a superficial lamellardisc was made by trephine and the lamellar separation was performed by Desmarre's scarifier. The disc was left hinged for 180 degrees making a lamellar pocket. Tattooing was done by the injection of the solutions under the iamellar pocket in 3 cases. As the results were not satisfactory we have adopted the filter paper method [Figure 2]. Whatman filter paper was selected for this purpose and the discs were prepared by the same trephine which was used for marking the cornea. First one filter paper disc was soaked with 2% gold chloride, the excess of solution was discarded by holding the disc vertically. Then the disc was introduced under the pocket and kept for 4 minutes. After removing this disc the second disc was prepared by similar method with 1% hydrazine hydrate solution. This disc was again introduced under the pocket and left for 3 minutes. After removal the washing was performed with fresh normal saline solution under pressure. Then the corneal flap was stitched back by three to four 8-0 monofilament sutures [Figure 3] Both the groups were periodically followed up. The maximum follow up being 18 months and minimum 6 months.
The main features are shown in [Table 1][Table 2]. In group A (conventional tattooing) 6 eyes suffered acute attacks of redness and watering mild to moderate in severity, along with corneal erosions [Figure 4] 6 eyes required tattooing twice, 2 eyes required it thrice, for satisfactory result but in all cases the pigment density went on steadily decreasing with time with patchy areas of pigment loss, thus vitiating cosmetic result [Figure 5]. In group B (lamellar pocket procedures), none of the cases presented with such attacks of redness though there was mild circum-corneal congestion in 2 cases, which disappeared in 2 weeks after suture removal, after which only one of the eyes was irritable where lamellar' flap was too superficial. The pigment density after an initial loss was nearly stabilized, the pigmentation was uniform and no patchy loss of pigment was seen even at the end of one year. None of the cases required tattooing more than once, if the initial tattooing was satisfactory [Figure 6].
The integrity of basement membrane is very essential for maintaining a strong and healthy epithelial lining of cornea. Injury to this membrane, mechanical, chemical or traumatic is cited as a cause of recurrent corneal erosions, an intractable and painful condition ,,.
If epithelium alone is removed leaving basement membrane intact, epithelium regenerates within 48 hours and its adhesion to underlying stroma is strong within 7 days as the original basement membrane is utilized for this purposes. However, if basement membrane is also removed, the adhesion takes upto 8 weeks to fully form and even then they are patchy and may not be of original strength. The corneal basement membrane acts as a scaffold for orderly epithelial cell replacement. Any traumatic abnormality of the basement membrane should compromise the bond between epithelium and stroma and could potentially result in recurrent erosive disorders. Infact, when basement membrane is experimentally damaged by any technique, the consistent sequalae do include irregularity and defects of epithelial surface.
Our main objection to tattooing done after scraping the epithelium is in its causing injury to basement membrane of corneal epithelium which may regenerate poorly, thus predisposing the eye to a condition akin to recurrent corneal erosions. This fact was proved by our observations in group A where 6 of the 10 eyes had periodic attacks of redness long after the surgery, upto 1 year.
The greater pigment density and its relative permanence in group B is understandable as by the lamellar procedure, two surfaces are being tattooed simultaneously, the corneal bed and the inner surface of the lamellar flap, thus duplicating the amount of pigment deposited in the cornea. Larger the pigment initially deposited in cornea, the greater is the density of tattooing and more durable are the results.
Though tattooing has been described after lamellar dissection of corneal tissue which after tattooing is restitcheds, this procedure has greater problems and increased morbidity owing to rather extensive surgery involved. The same results are achieved by lamellar pocket with a less extensive surgery and problems.
An evaluation of corneal tattooing done under lamellar corneal disc in 10 cases of unsightly corneal opacities is presented and results are compared with standard tattooing done after epithelial scraping. The main advantages seen with lamellar pocket procedure are prevention of recurrent corneal erosions and a more lasting retention of pigment thereby giving a more permanent cosmetic result.
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