Techniques for CHANGING eye color for cosmetic purposes

In ophthalmology, there is growing demand for cosmetic eye color change surgery for a variety of reasons. It therefore seems important to review the different techniques currently available in order to be able to advise patients and inform them of the potential risks.

COLORED CONTACT LENSES for AESTHETIC purposes

Colored lenses are the most common technique for eye coloring. They account for approximately 7% of the global contact lens market. When used under medical supervision, colored lenses are no more risky than corrective lenses. However, the lack of medical supervision and poor practices associated with wearing these types of lenses (wearing them at night, lack of information, lack of medical supervision, etc.) increase the risk of infection, with a higher rate of bacterial keratitis than that found with corrective lenses.

LASER DEPIGMENTATION

This technique, which is rarely performed in France, is more commonly practiced in other countries. It involves using a YAG laser to remove the melanin pigment from the iris, revealing the grayish iris stroma. The main disadvantage of this technique is that it does not allow for color selection. A few cases of hypertonia or inflammatory reactions have been reported. Numerous sessions are required to achieve visible results, which are often only noticeable in bright light conditions.

PRE-IRIS IMPLANTS FOR AESTHETIC PURPOSES

Since 2006, two iris implants have been developed to change eye color:
  • New Color Iris (KHAN Medical)
  • Bright Ocular (Stellar Device)
Neither of these implants has obtained CE marking (European conformity) or FDA approval (US Food and Drug Administration) These implants are silicone discs (approximately 12 mm in diameter) with a pupil of approximately 3.5 mm held in place by haptics that rest in the iridocorneal angle. Very few patients have undergone surgery in Europe, but they are still being implanted in some countries. Although the aesthetic results are impressive, the complication rate of over 50% makes them very dangerous and often leads to their removal. The most common complications include iris atrophy, hypertension (risk of glaucoma), and endothelial cell loss, which can lead to corneal transplantation. In short, due to its high complication rate, this technique requires regular endothelial and tension monitoring and threatens visual function (risk of blindness), and should therefore be avoided. It is the duty of all ophthalmologists to dissuade any patient who wishes to use this technique, which is sometimes touted on social media.

CORNEAL KERATOPIGMENTATION (FLAAK) FOR COSMETIC PURPOSES

Initially performed for cosmetic purposes to treat post-traumatic aniridia or iris defects. Corneal keratopigmentation was first described by GALEN as a way to mask leukoma corneal opacities. The technique involved cauterizing the cornea and then injecting an intracorneal pigment (such as copper sulfate). Then, in the 19th century, corneal tattoos were described as being performed with a needle and Indian ink. Today, corneal keratopigmentation has evolved, demonstrating its aesthetic value in improving the appearance of traumatized irises or for bothersome functional symptoms (photophobia, diplopia) in certain pathologies: iris coloboma, aniridia, Urets-Zavalia syndrome, etc. The use of new pigments, the advent of femtosecond lasers, and the safety of this technique have led to its use being extended to purely cosmetic purposes. Today, FLAAK involves injecting pigment into an annular tunnel created by a femtosecond laser. The use of the femtosecond laser ensures precision and safety and greatly facilitates the procedure. The tunnel is created with a thickness of approximately 200 microns.

CONCLUSION

Today, due to its safety and aesthetic results, FLAAK has established itself as the gold standard technique for cosmetic eye color change surgery. Femtosecond laser-assisted corneal keratopigmentation (FLAAK) therefore appears to be the technique with the most scientific evidence and the best results.