Keratopigmentation to change eye color

On TikTok it is one of the new (dangerous) trending themes. Changing eye color is possible thanks to a specific ocular surgery. Those who have always dreamed of having light eyes, rather than dark ones, can therefore see their dream come true by undergoing an operation that does not require much time, but which proves to be very delicate and not suitable for everyone.
Among those who chose it there is also Francesco Chiofalo, former competitor of Temptation Island And The Babe and the Nerdwhich just recently – as we read above Daily fact – revealed that he had undergone keratopigmentation, the surgical operation that allowed him to have a “new” pair of blue eyes, like other members of his family.

But keratopigmentation is not a risk-free procedure. Given that we are leaving the realm of ocular health to enter that of pure aesthetics, it is worth highlighting that this very delicate technique – and not one hundred percent safe – was born for very specific reasons. We talked about it with the doctor Barbara Prandispecialist in Ophthalmology and Refractive Surgery at Clinica Baviera.

Doctor, what is “keratopigmentation” and what exactly is it for?
«It is one of the methods proposed to change the color of the eyes. The latter depends on the color of the iris, a ring-shaped structure with a hole of variable diameter called the pupil in the center. Depending on the amount of brown pigment (melanin) that the iris contains, the color can vary from very light blue (little melanin) to dark brown (a lot of melanin), with all the intermediate shades. Specifically, keratopigmentation is a procedure that can be performed manually or using the femtosecond laser. Currently the most widespread is FAK (femtosecond laser-assisted intra-stromal keratopigmentation)”.

What exactly does the intervention consist of?
«It consists of creating an annular tunnel with the laser within the thickness of the cornea (the transparent structure in front of the iris) with an external diameter of approximately 9.5 mm and an internal diameter of 5.5 mm , at a depth of approximately 250 microns. A quantity of pigment of different colors is inserted into this sort of “pocket”. Since this pocket covers the iris behind it, when the eye is looked at from afar the effect is that the color of the pigment overlaps with the color of the iris. Therefore if a lot of pigment is superimposed on a dark iris
clear the final effect will be an apparent blue-green colour. Keratopigmentation was introduced many years ago for aesthetic purposes to “mask” post-traumatic corneal opacities in blind eyes in order to improve at least the aesthetic appearance, without having to resort to prosthetics. The current technique is instead applied on functioning eyes for a mere aesthetic purpose.”

Does it actually allow you to obtain any color shade?
«The pigments currently available are micronized and appear to have good stability. The colors available are different and by varying the amount of pigment inserted you can obtain many different shades. The color can be simulated pre-operatively with digital photo-editing techniques.”

Is it a simple operation that can be performed in any specialized centre?
«The intervention it lasts approximately 10-15 minutes and is performed under topical anesthesia. It is not complex, however it is carried out on a highly sensitive structure of the eye (the cornea) and requires the use of a femtosecond laser to create the tunnel. It is therefore microsurgery that is not free from intra- or post-operative complications.”

What are the risks or possible side effects?
«The main complications can be one tunnel drilling, infection of
wound, dispersion of pigment into other ocular structures, abnormal healing with
induction of alteration of refraction (astigmatism).
Cases have been described marked photosensitivity (light intolerance) for damage to
subcorneal nerve plexuses. Also worth mentioning is the inability to explore properly
during the eye examination the structures behind the pigment, therefore the iris, the retinal periphery (especially in myopic and diabetic patients) and the camerular angle. This can lead to a missed diagnosis of important eye pathologies (such as glaucoma, diabetic retinopathy, the presence of peripheral retinal tears) and also to the impossibility of applying the appropriate treatments: for example the presence of the pigment can hinder the performance of laser treatments on the retina, with very serious consequences for eye health and vision. For example, if a retinal tear is not treated promptly it can lead to retinal detachment and vision loss.
Furthermore the follow-up of patients who have already undergone surgery does not even last 10 years, so potential long-term complications are still unknown. Among them the most fearsome is thestructural weakening of the cornea with possible ectatic complications (tendency towards flattening of the cornea weakened by the tunneling). There is certainly a need for further research in this area.
It is important to underline, however, that compared to other techniques to change eye color, keratopigmentation is currently considered the safest. The other techniques – such as iris depigmentation with yag laser and above all theartificial iris implant on the natural iris can even lead to blindness or the need for glaucoma or cataract surgery or cornea transplant with permanent damage to the ocular structures. In fact, currently, artificial iris implantation for cosmetic purposes is considered one
illegal practice in the medical field”.

Can anyone undergo keratopigmentation or are there specific requirements?
«Personally, it is a technique that I don't practice, because I don't consider it sufficiently studied yet. I would rule it out a priori the patients with thin cornealess than 500 microns, patients suffering from glaucoma or autoimmune diseases affecting the cornea and irisas well as i diabetic patients in which the possibility of fully exploring the ocular structures would be limited.”

From an aesthetic point of view, the phenomenon is spreading through social networks, especially through videos published by boys and girls who have undergone the operation: what is the danger of this “new trend”?
«The danger is that of incurring the complications we talked about
permanent vision impairmentso this phenomenon should be curbed
as soon as possible or we will find ourselves with many young people with serious eye problems in the
near future, not easy to treat”.