Corneal Tattooing with Amniotic Membrane

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Corneal Tattooing with Amniotic Membrane

• Woo Chan Park M.D., Won Yeol Ryu M.D.
• Dept. of Ophthalmology, College of Medicine,
  Dong-A University
• Busan, Korea
• The authors have no financial interest in the
  subject matter of this poster.

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PURPOSE

• The purpose of this study was to investigate the
  effects of Davidson Marking Dye tattooing with
  permanent amniotic membrane transplantation (AMT)
  on treatment of corneal opacity and/or bullous
  keratopathy in patients who suffered from pain,
  photophobia and cosmetic problem.

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METHODS

• We performed corneal tattooing with amniotic
  membrane transplantation in 27 eyes with corneal
  opacity and/or bullous keratopathy in patients
  who suffered cosmetic problem, pain, poor visual
  potential, photophobia from January 2002 to July
  2009.
• The average age of the study group was 57.7 years
  old (MF1611) and the average follow-up period
  was 7.6 months (226 months)(Table 1).

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Table 1. Demography Table 1. Demography Table 1. Demography Table 1. Demography Table 1. Demography Table 1. Demography Table 1. Demography Table 1. Demography
Case Sex/Age Op. site Preop. cause Pre-op. V/A Pain Photo-phobia Follow-up
1 F/63 OD Ocular trauma FC Yes Yes 2
2 F/64 OD Post-infectious corneal opacity HM Yes Yes 2
3 F/64 OS Post-infectious corneal opacity LP() Yes Yes 4
4 M/31 OD Ocular trauma 0.1 Yes Yes 2
5 M/43 OS Ocular trauma 0.06 Yes Yes 5
6 F/37 OD Lipid keratopathy 0.08 Yes Yes 3
7 M/60 OD Ocular trauma HM Yes Yes 5
8 M/64 OD Ocular trauma 0.06 Yes Yes 12
9 M/75 OS Ocular trauma HM Yes Yes 2
10 F/27 OS Lipid keratopathy 0.1 Yes Yes 8
11 M/53 OD Corneal ulcer LP(-) Yes No 3
12 M/67 OD Glaucoma LP() Yes Yes 6
13 M/81 OD Glaucoma FC Yes Yes 6
14 M/62 OS Glaucoma 0.06 Yes Yes 14
15 F/71 OS Ocular trauma HM Yes Yes 26
16 M/57 OS Post-infectious corneal opacity 0.1 Yes Yes 17
17 F/62 OS Ocular trauma FC Yes Yes 7
18 M/40 OS Pseudophakia, glaucoma LP(-) Yes Yes 2
19 M/72 OD PED LP() Yes Yes 9
20 F/63 OD Pseudophakia, glaucoma 0.02 Yes Yes 5
21 M/76 OD PED 0.04 Yes Yes 4
22 M/57 OD Ocular trauma HM Yes Yes 5
23 M/54 OS Ocular trauma HM Yes Yes 22
24 F/53 OS Post-infectious corneal opacity 0.04 Yes Yes 18
25 M/66 OD Pseudophakia, glaucoma 0.02 Yes Yes 6
26 F/50 OD Post-infectious corneal opacity LP() Yes No 4
27 F/45 OS Corneal ulcer FC Yes Yes 6
V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect

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METHODS

• Under the topical anesthesia, corneal epithelium
  was removed using No. 15 blade (Fig. 1-A) and the
  Davidson marking dye was applied on the cornea.
  We performed multiple punctures with 23G needle
  into the anterior stroma (Fig. 1-B,C).
• The amniotic membrane was designed smaller than
  epithelial debridement diameter (Fig. 1-D) and
  was placed on the cornea and was sutured
  purse-string manner with 10-0 nylon (Fig. 1-E,F).
• Therapeutic soft lens was worn and pressure patch
  was done.
• Postoperatively, we assessed the resolution of
  pain and photophobia, and the persistence of the
  dye tattooing.

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Fig. 1. Procedure of tattooing and amniotic
membrane transplantation (AMT) (AF)
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RESULTS

• Postoperative pain relief was obtained in 25 eyes
  out of 27 eyes (92.6), and the photophobia was
  improved in 24 eyes of 27 eyes (96) (Table 2).
• The dye was disappeared more than 50 in only 2
  eyes (Fig. 25).
• In 1 eye (case 11), evisceration was carried out
  due to ocular hypertension. And in another 1 eye
  (case 22), permanent amniotic membrane
  transplantation was performed due to persistent
  corneal epithelial defect.
• Postoperative visual acuity was similar to the
  preoperation.

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Table 2. Surgical outcome Table 2. Surgical outcome Table 2. Surgical outcome Table 2. Surgical outcome Table 2. Surgical outcome Table 2. Surgical outcome Table 2. Surgical outcome
Case Preop. cause Post-op. V/A Pain? Pain? Photophobia? Loss of dye (gt50)
1 Ocular trauma 0.02 O O O -
2 Post-infectious corneal opacity HM O O O -
3 Post-infectious corneal opacity LP() O O O -
4 Ocular trauma 0.08 O O O -
5 Ocular trauma 0.06 O O O -
6 Lipid keratopathy 0.1 O O O -
7 Ocular trauma HM O O - -
8 Ocular trauma 0.08 O O O -
9 Ocular trauma HM O O O -
10 Lipid keratopathy 0.1 O O O -
11 Corneal ulcer, glaucoma LP(-) - - No -
12 Glaucoma LP() O O O -
13 Glaucoma FC O O O -
14 Glaucoma 0.08 O O O -
15 Ocular trauma FC O O O O
16 Post-infectious corneal opacity 0.1 O O O -
17 Ocular trauma FC O O O -
18 Pseudophakia, glaucoma LP(-) O O O -
19 PED LP() O O O -
20 Pseudophakia, glaucoma 0.02 O O O -
21 PED 0.04 O O O -
22 Ocular trauma HM - - - -
23 Ocular trauma FC O O O O
24 Post-infectious corneal opacity 0.04 O O O -
25 Pseudophakia, glaucoma 0.02 O O O -
26 Post-infectious corneal opacity LP() O O No -
27 Corneal ulcer FC O O O -
25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4) 25/27 (92.6) 23/25 (96.0) 2/27 (7.4)
V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect V/Avisual acuity, FCfinger count, HMHand movement, LPlight perception, PEDpersistent corneal epithelial defect

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B
A
Fig. 2. Case 5. Ectopic pupil Partial dye-AMT
was done. A. POD 1 day B. POD 6 months,
dye was still remained
Fig. 3. Case 16. Traumatic aniridia Hole dye-AMT
pupilloplasty were done. A, POD 3 months
B. stained with fluororescein
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Fig. 4. Case 14. Bullous keratopathy Hole
dye-AMT was done. A. POD 1 day, B. POD 5 days,
C. POD 1 week, reepithelialization was done D.
POD 14 months, dye was nearly disappeared
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Fig. 5. Case 21. Herpetic keratitis with
persistent corneal epithelial defect Dye-AMT was
done. A. POD 3 days B. POD 1 week C.
POD 2 months D. POD 8 months, dye was still
remained
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CONCLUSIONS

• The combined operation of corneal tattooing
  and amniotic membrane transplantation is a good
  choice for treatment of corneal opacity and/or
  bullous keratopathy with regard to cosmetic
  problem, pain, and photophobia.