Intrastromal keratopigmentation for photophobia secondary to traumatic aniridia

Abstract

Purpose: To present a case of therapeutic intrastromal keratopigmentation to resolve intractable photophobia secondary to traumatic aniridia in a hypotonus eye.

Observations: A 66-year-old male presented with intractable photophobia for several years in the left eye following a ruptured globe and multiple subsequent retinal surgeries for retinal detachments complicated by proliferative vitreoretinopathy. The patient underwent intrastromal keratopigmentation given surgical limitations due to the presence of hypotony and silicone oil dependence. The patient's symptoms were fully resolved, and the pigmentation remained stable at 18 months.

Conclusions/importance: Keratopigmentation can be an effective surgical approach to managing patients with symptomatic photophobia in eyes where intraocular surgery is not an amenable option.

Keywords: Corneal tattoo; Globe trauma; Keratopigmentation; Photophobia; Traumatic aniridia.

Fig. 1

External photograph montage of the left eye. (A) Fundus retroillumination revealing the absence of iris tissue and stump, and aphakia with moderate corneal edema. (B) Fundus retroillumination following intrastromal keratopigmentation demonstrating blocking of the peripheral to mid-peripheral cornea from pigmentation. (C) Direct, diffuse illumination showing color pigmentation to match the fellow eye, with white pigment from stromal punctures to mimic the iris texture. The artificial pupil was left a 6 mm to allow for visualization of the posterior segment pathology. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)