1. Corneal Tattooing with Amniotic Membrane Woo Chan Park M.D., Won Yeol Ryu M.D. Dept. of Ophthalmology, College of Medicine, Dong-A University Busan, Korea The authors have no financial interest in the subject matter of this poster.

2. Page  2  The purpose of this study was to investigate the effects of Davidson Marking Dye tattooing with permanent amniotic membrane transplantation (AMT) on treatment of corneal opacity and/or bullous keratopathy in patients who suffered from pain, photophobia and cosmetic problem. PURPOSE

3. Page  3  We performed corneal tattooing with amniotic membrane transplantation in 27 eyes with corneal opacity and/or bullous keratopathy in patients who suffered cosmetic problem, pain, poor visual potential, photophobia from January 2002 to July 2009.  The average age of the study group was 57.7 years old (M:F=16:11) and the average follow-up period was 7.6 months (2~26 months)(Table 1). METHODS

4. Page  4 Table 1. Demography CaseSex/AgeOp. sitePreop. causePre-op. V/APainPhoto-phobiaFollow-up 1F/63ODOcular traumaFCYes 2 2F/64ODPost-infectious corneal opacityHMYes 2 3F/64OSPost-infectious corneal opacityLP(+)Yes 4 4M/31ODOcular trauma0.1Yes 2 5M/43OSOcular trauma0.06Yes 5 6F/37ODLipid keratopathy0.08Yes 3 7M/60ODOcular traumaHMYes 5 8M/64ODOcular trauma0.06Yes 12 9M/75OSOcular traumaHMYes 2 10F/27OSLipid keratopathy0.1Yes 8 11M/53ODCorneal ulcerLP(-)YesNo3 12M/67ODGlaucomaLP(+)Yes 6 13M/81ODGlaucomaFCYes 6 14M/62OSGlaucoma0.06Yes 14 15F/71OSOcular traumaHMYes 26 16M/57OSPost-infectious corneal opacity0.1Yes 17 F/62OSOcular traumaFCYes 7 18M/40OSPseudophakia, glaucomaLP(-)Yes 2 19M/72ODPEDLP(+)Yes 9 20F/63ODPseudophakia, glaucoma0.02Yes 5 21M/76ODPED0.04Yes 4 22M/57ODOcular traumaHMYes 5 23M/54OSOcular traumaHMYes 22 24F/53OSPost-infectious corneal opacity0.04Yes 18 25M/66ODPseudophakia, glaucoma0.02Yes 6 26F/50ODPost-infectious corneal opacityLP(+)YesNo4 27F/45OSCorneal ulcerFCYes 6 V/A=visual acuity, FC=finger count, HM=Hand movement, LP=light perception, PED=persistent corneal epithelial defect

5. Page  5  Under the topical anesthesia, corneal epithelium was removed using No. 15 blade (Fig. 1-A) and the Davidson marking dye was applied on the cornea. We performed multiple punctures with 23G needle into the anterior stroma (Fig. 1-B,C).  The amniotic membrane was designed smaller than epithelial debridement diameter (Fig. 1-D) and was placed on the cornea and was sutured purse-string manner with 10-0 nylon (Fig. 1-E,F).  Therapeutic soft lens was worn and pressure patch was done.  Postoperatively, we assessed the resolution of pain and photophobia, and the persistence of the dye tattooing. METHODS

6. Page  6 Fig. 1. Procedure of tattooing and amniotic membrane transplantation (AMT) (A~F) A F C E D B

7. Page  7  Postoperative pain relief was obtained in 25 eyes out of 27 eyes (92.6%), and the photophobia was improved in 24 eyes of 27 eyes (96%) (Table 2).  The dye was disappeared more than 50% in only 2 eyes (Fig. 2~5).  In 1 eye (case 11), evisceration was carried out due to ocular hypertension. And in another 1 eye (case 22), permanent amniotic membrane transplantation was performed due to persistent corneal epithelial defect.  Postoperative visual acuity was similar to the preoperation. RESULTS

8. Page  8 Table 2. Surgical outcome CasePreop. causePost-op. V/APain↓Photophobia↓Loss of dye (>50%) 1Ocular trauma0.02OO- 2Post-infectious corneal opacityHMOO- 3Post-infectious corneal opacityLP(+)OO- 4Ocular trauma0.08OO- 5Ocular trauma0.06OO- 6Lipid keratopathy0.1OO- 7Ocular traumaHMO-- 8Ocular trauma0.08OO- 9Ocular traumaHMOO- 10Lipid keratopathy0.1OO- 11*Corneal ulcer, glaucomaLP(-)-No- 12GlaucomaLP(+)OO- 13GlaucomaFCOO- 14Glaucoma0.08OO- 15Ocular traumaFCOOO 16Post-infectious corneal opacity0.1OO- 17Ocular traumaFCOO- 18Pseudophakia, glaucomaLP(-)OO- 19PEDLP(+)OO- 20Pseudophakia, glaucoma0.02OO- 21PED0.04OO- 22*Ocular traumaHM--- 23Ocular traumaFCOOO 24Post-infectious corneal opacity0.04OO- 25Pseudophakia, glaucoma0.02OO- 26Post-infectious corneal opacityLP(+)ONo- 27Corneal ulcerFCOO- 25/27 (92.6%) 23/25 (96.0%) 2/27 (7.4%) V/A=visual acuity, FC=finger count, HM=Hand movement, LP=light perception, PED=persistent corneal epithelial defect

9. Page  9 Fig. 3. Case 16. Traumatic aniridia Hole dye-AMT & pupilloplasty were done. A, POD 3 months B. stained with fluororescein Fig. 2. Case 5. Ectopic pupil Partial dye-AMT was done. A. POD 1 day B. POD 6 months, dye was still remained B A A B

10. Page  10 B A D C Fig. 4. Case 14. Bullous keratopathy Hole dye-AMT was done. A. POD 1 day, B. POD 5 days, C. POD 1 week, reepithelialization was done D. POD 14 months, dye was nearly disappeared

11. Page  11 B A D C Fig. 5. Case 21. Herpetic keratitis with persistent corneal epithelial defect Dye-AMT was done. A. POD 3 days B. POD 1 week C. POD 2 months D. POD 8 months, dye was still remained

12. Page  12 The combined operation of corneal tattooing and amniotic membrane transplantation is a good choice for treatment of corneal opacity and/or bullous keratopathy with regard to cosmetic problem, pain, and photophobia. CONCLUSIONS