title: Novel lamellar, flap-based tattooing techniques for corneal opacities in scarred and vascularized blind eyes.
abstract: OBJECTIVE
  The aim of this study was to describe novel, flap-based tattooing techniques for the treatment of disfiguring corneal scars in blind eyes.
  
  
  METHODS
  Several new modifications of intrastromal corneal tattooing techniques were performed in 6 patients. In corneas with a low risk of perforation, a large limbus-to-limbus lamellar flap was prepared, and the tattooing dyes were spread over the entire stromal bed. After additional puncturing of the dyes into the stroma, the flap was closed and sutured ("large flap technique"). In fragile corneas where convenient preparation of a large flap was not possible, a central small flap was prepared, and the "pupil" was tattooed in analogy ("small flap technique"). Afterward, the corneal periphery corresponding to the "iris" was tattooed, either by puncturing or injecting the dye into peripheral intrastromal tunnels ("tunnel technique").
  
  
  RESULTS
  Two eyes were tattooed using a large flap, and 4 eyes were tattooed using a small flap. Here, the corneal periphery of 3 eyes was tattooed by puncturing, whereas 1 eye was tattooed using the tunnel technique. All tattooing procedures were performed without complications and with good cosmetic results.
  
  
  CONCLUSIONS
  These novel, flap-based tattooing techniques are alternatives to previously reported procedures and can be adapted to the individual corneal constitution. Further, the tunnel technique is an easy-to-perform method that provides good tattooing results.
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Hos
authors.forename: Ludwig M
authors.initials: LM
authors.lastname: Heindl
authors.forename: Franziska
authors.initials: F
authors.lastname: Bucher
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002921:Cicatrix / Q000150:complications / Q000601:surgery*; D016510:Corneal Neovascularization / Q000150:complications / Q000601:surgery*; D003318:Corneal Opacity / Q000209:etiology / Q000601:surgery*; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps; D013653:Tattooing / Q000379:methods*