Therapeutic keratopigmentation Vis-à-Vis in blind eyes: complications and outcomes in a series of 184 eyes

Abstract

Purpose To evaluate the outcomes, complications, and patient satisfaction following therapeutic keratopigmentation Vis-à-Vis in blind eyes. Methods This retrospective case series included 184 eyes from blind patients who underwent KTP between 2016 and 2024, using either inorganic or mixed pigments. Superficial automated, superficial manual, and intrastromal manual approaches were performed according to corneal indication. Data collected comprised demographic information, surgical techniques, pigment type, postoperative complications, re-epithelialization time, and long-term stability. Patient-reported outcomes regarding cosmetic satisfaction and quality-of-life impact were also assessed. Results The overall median re-epithelialization time was 14 days, though delayed healing occurred in < 20% of the patients. Postoperative complications included pigment fading, infectious keratitis, photophobia and corneal melting, though most were manageable and did not compromise final cosmetic outcomes. Cases of MRI-related ocular discomfort were noted in eyes pigmented with iron oxide–based compounds but resolved without structural alterations. At final follow-up, cosmetic appearance was graded as good to excellent in 90% of cases, and 88% of patients expressed high satisfaction, reporting improved psychosocial wellbeing. Conclusion Therapeutic keratopigmentation Vis-à-Vis emerges as a meaningful intervention for blind eyes, not merely restoring external harmony but also restoring dignity and quality of life. Even with a tangible risk of complications, long-term pigment stability and high satisfaction rates highlight its value as both a reconstructive and humanizing procedure in corneal surgery.

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