Long-term effects and considerations of keratopigmentation on cataract surgery

Keratopigmentation, also known as corneal tattooing, is an advanced procedure designed to enhance the appearance of the eye by changing the cornea's color. Originally developed for therapeutic purposes, it has gained popularity as an elective cosmetic procedure. However, if you are considering cataract surgery in the future, it is essential to understand how keratopigmentation may impact the procedure and your long-term eye health.

At Sharmina Khan’s Eye Clinic, we believe in providing our patients with the most comprehensive insights into vision correction procedures. If you have undergone keratopigmentation or are considering it, here’s what you need to know about its long-term effects and how it could influence your cataract surgery.

How keratopigmentation works

Keratopigmentation involves depositing pigment into the corneal stroma (the middle layer of the cornea) to achieve the desired color change. The pigment may be applied using a femtosecond laser-assisted technique or manual injection, depending on the specific case. The result is a permanent alteration of the eye’s appearance.

While keratopigmentation is primarily a cosmetic enhancement, some patients seek the procedure for therapeutic reasons, such as improving the appearance of corneal scars or iris defects.

Potential long-term effects of keratopigmentation

1. Changes in corneal clarity
   Over time, the pigment may affect light transmission through the cornea, potentially causing glare, halos, or reduced contrast sensitivity.
2. Impact on corneal biomechanics
   Some studies suggest that keratopigmentation could slightly alter the structural integrity of the cornea, which may affect surgical outcomes in the future.
3. Inflammation and Healing Response
   The introduction of pigment may trigger a long-term immune response in some individuals, leading to chronic inflammation or mild corneal haze.
4. Possible Migration or Fading of Pigment
   Over time, pigment particles may disperse or fade, affecting the uniformity of color and, in some cases, necessitating a touch-up procedure.

How keratopigmentation affects cataract surgery

Cataract surgery involves removing the eye’s natural lens and replacing it with an artificial intraocular lens (IOL). Since the procedure requires precise visualisation of the eye’s internal structures, keratopigmentation can present certain challenges:

• Reduced surgical visibility – Pigmentation can obscure the surgeon’s ability to clearly visualise the anterior chamber and the lens.
• Impact on measurements for IOL selection – The pigment may affect the accuracy of pre-surgical biometric calculations, which are essential for choosing the correct IOL power.
• Changes in light transmission – Depending on the density of pigmentation, light reaching the retina may be altered, impacting postoperative vision quality.
• Risk of additional corneal trauma – If pigment has been deposited deeply, there is a small risk that the cornea may respond differently to surgical instruments.

What you should consider before cataract surgery

If you have undergone keratopigmentation and require cataract surgery, consider the following:

1. Discuss your history with your cataract surgeon
   It is crucial to inform your surgeon about your keratopigmentation procedure so they can plan accordingly.
2. Advanced imaging and testing
   Specialised scans such as OCT (optical coherence tomography) and corneal topography may be needed to assess the impact of pigmentation on surgical planning.
3. Selection of IOLs
   Patients with keratopigmentation may not be suitable for multifocal intraocular lenses leaving you reliant on reading glasses.
4. Consider timing
   If you are considering both procedures, it may be best to undergo cataract surgery before your cataract becomes too advanced.

Find out if cataract surgery is right for you

If you have undergone keratopigmentation and are concerned about cataract surgery, book a free assessment to see how we can help you achieve the best vision outcomes.