This retrospective study looked at differences in epithelial smoothing in patients with bullous keratopathy (BK) undergoing either corneal tattooing or anterior stromal puncture (ASP). Both procedures were carried out for symptomatic relief in eyes with poor visual potential. Chinese ink was introduced into the cornea with 25G or 27G needle in the area of bullae formation. After procedure both groups used bandage contact lenses and antibiotic drops to promote re-epithelisation. Thirty-one patients treated with corneal tattooing had statistically significant reduction in bullae formation compared to nine patients treated with ASP at three months. Of the 90.3% of patients in corneal tattooing group 90.3% were symptom free at three months, whereas 100% of ASP treated patients were still symptomatic at the same time point. The authors postulate that Chinese ink injected into corneal stroma induces inflammatory reaction within the cornea which results in stronger epithelium adhesion and reduction in bullae formation. This, however, has not been histologically evaluated. Although a small sample with short follow-up, corneal tattooing seems to be an interesting treatment option for patients with BK and poor visual potential. Further reports of more patients with longer follow-ups are needed to prove if indeed corneal tattooing is a valuable long-term option for BK patients to relieve their symptoms.

Corneal tattooing and anterior stromal puncture for treating symptomatic bullous keratopathy.
Lin HC, Wang YL, Chen G, et al.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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