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ANIRIDIA tatoo

Q:

Dear Emyl
I´m thinking if is a good case for corneal tattoo this case ?
She is blind since child
I would like to know more details about your thecnique
What does it means  and how do you do
” injecting the ink orthogonal to the corneal surface using fine tattoo needles”
Thanks
A:
hi ronal

i think this would be a good case for several reasons:
1. it seems like a NLP eye, so there is no downside risk
2. brown eyes are easier to color match
3. the pathology is mostly posterior, eg there isn’t a huge pannus or band keratopathy which can inhibit ink uptake
4. the eye looks otherwise normal (ie normal-sized, not shrunken) so it will have a good cosmetic result
there are many other ways to do this, involving injecting ink with a needle into the stroma
i don’t like this approach, as it is difficult to precisely control the dispersion, even if you make some type of pocket
also then it’s impossible to make an iris, all you get is a black spot, which is better than white, but not great
i like to use a tattoo machine, there are many on the market that you can buy online for under $1000 all-included
make sure you choose one that has continuously variable oscillation/Hz, so you can go down below 10Hz for control
older/cheaper machines have too much initial starting resistance, so you if you try to go down on Hz, the unit stops
you also need good control of maximum extension, this helps avoid perforations (by giving more control)
it’s not like you can go down to less than the thickness of the cornea, actually
but i find that a lower travel length does help you control how deep you go, actually
i suppose this is why they have that control, as it probably helps you visually control depth in the skin
go with a 3-needle cluster, 1 needle takes forever and is very hard to get even coverage
more than 3 needles sacrifices quality for control
you can buy special ink with fine particulate size that has been centrifuged and the larger particles discarded
this is more expensive and hard to find, i haven’t noticed a huge benefit to doing so, only a small benefit
afterwards just put on a BCL and give some steroid QID, taper by 1 drop per week, plus an ABx BID x 1 wk
dc BCL at 1 week
if you have anterior pathology like bad band-k, for ex, you should remove the epi with EtOH like a LASEK and remove it
sometimes i use EDTA, sometime i add manual stripping/debridement, sometimes PTK, sometimes burr–depends on path
for this i don’t think you need any of those modalities, so you can even leave the epithelium on (although it will prob come off ie slough off as you do the tattoo, in which case you then should remove it cleanly with a LASEK EtOH trephenation)
i think there should be some pics and a video of some of my cases on my website below
if not, just google my name + “discovery channel” and “tattoo” and you can pull some relevant videos/pics up
should point out that i was first taught this technique by Doyle Stulting, MD  PhD while a Cornea Fellow at Emory in 1996
good luck, let me know how it goes, and perhaps post some nice pre/post pics on knet if so we can see how it goes
have a nice weekend, everyone!
emil

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