Refers to FLAAK

Keratopigmentation or FLAAK

Formerly known as corneal tattoo, it has been used for centuries to treat patients suffering from corneal opacities.

It is interesting to know that the history of corneal tattooing dates back 2000 years to the time when Galen, the Greek physician, first introduced this method. The same technique was later redefined by Aetius in 450 AD and applied to cover white opacities of the eye.

Both physicians first burned the corneal surface and then applied the pigments, such as powdered walnut, iron, and copper sulfate, on the eye surface. Over the years, corneal tattooing has been used in different ways and has undergone evolution and improvement.

Learn why is it worth it

The new era of Keratopigmentation

Keratopigmentation was developed in 2000 to reconstruct damaged eyes and irises. The safety of the cornea biocompatible pigments, the quality of the results obtained, and patient satisfaction contributed to the spread of this technique into the field of cosmetic and eye color change since 2010.

This technique enables the ophthalmologist to alter the patient’s eye color to their desired color. The pigments used in this technique are very close in structure to natural pigments in the human eye. That is why the operation result and the resulting eye color are closely similar to the natural eye color. These pigments are fully compatible with corneal tissue and have received (CE) approval for use in the European Union.

It should be noted that the colors used in this procedure include a spectrum of 17 different colors, including green, emerald green, pistachio green, cerulean blue, Mediterranean blue, cedar, browns, gray, and honey. You should keep in mind that the resulting eye color after the Keratopigmentation procedure may slightly differ from your desired intensity and shade.

Is Keratopigmentation reversible?

While the reversibility of Keratopigmentation using a laser has been claimed, it should be emphasized that this operation is not completely reversible. So, please be careful and make sure to choose the right type and shade of color with the help of reliable simulators before the procedure. Remember that you can only change the selected color if you are unsatisfied with the result. However, you cannot safely remove the color from the corneal layers and change back to your original eye color without consequences.

Is Keratopigmentation permanent?

Keratopigmentation is a permanent, irreversible method of changing eye color. However, in 30% of people, the pigments introduced to the cornea can fade over time, and color restoration is necessary after the surgery. During the touch-up procedure, additional pigment is placed in the previous site to restore the original color. The best time for a touch-up procedure may vary from one to several years after the surgery.

Therapeutic applications of Keratopigmentation

Keratopigmentation surgery was first used for therapeutic purposes, such as reconstructing pathological iris or corneal abnormalities. These abnormalities are often result from physical trauma, surgical complications, congenital anomalies, infectious sequelae, or damage due to colored iris implants and so forth.

Keratopigmentation is also used to improve ocular function and restore the aesthetic conditions of the eye in patients suffering from the following conditions:

  • Corneal scarring or whitening due to transplantation, trauma, and infection, among others.
  • Iris coloboma or abnormal pupil (iris appears like a keyhole or cat eye).
  • Partial or complete aniridia (a portion or the entire iris is missing)
  • Albinism or absence of iris pigmentation to reduce light sensitivity (those who have white eyes and skin color)
  • Permanent mydriasis (dilated pupils that are persistently dilated and do not constrict)

Satisfaction of patients undergoing Keratopigmentation procedure

According to a research study published in the prestigious journal BMC Ophthalmology in 2023, 42 subjects who underwent Keratopigmentation were interviewed, and their health and satisfaction after the operation were assessed. Some individuals experienced pain and prickling only on the procedure day and the day after. A few people reported pain and prickling a few months after surgery. However, these symptoms were fully resolved after this time, and no serious adverse effect was seen or reported. Overall, the subjects expressed high satisfaction with the results of this method. Moreover, another study reported the percentage of people satisfied with Keratopigmentation for purely cosmetic purposes.

  • Keratopigmentation: a comprehensive review, Eye (Lond). 2020 Jun; 34(6): 1039–1046.

  • Cosmetic Change of the Apparent Color of the Eye: A Review on Surgical Alternatives, Outcomes and Complications, Ophthalmology and Therapy. 2022 Apr; 11(2): 465–477.

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