To the Editor:
Emerging novel Keratopigmentation (KTP) techniques have broadened its clinical applications for functional purposes through its therapeutic effects to ameliorate visual disturbances due to disabling light scattering in setting of iris defects such as aniridia, iris coloboma and large iridectomies [1, 2]. I agree that a combined approach using all available technologies combining the optical behaviour of the cornea by incorporating sensitivity of wavefront sensing can be advantageous to reach maximum visual performance in sighted eyes undergo KTP. However, it seems a reasonable option once the patients have regular corneal surface. A significant challenge in performing KTP using wavefront analysis is the contribution of unknown wound healing processes in the ultimate visual quality in pathologic corneas. In addition, disfiguring nature of iris defects, identifying the exact sectoral location of the maximum aberration and the vulnerability of wavefront interpretations to the size of pupil and amount of light penetration may limit favourable optical outcomes and should be considered in preoperative evaluations in such patients.
References
da Silva Ricardo JR, Medhi J, Pineda R. Femtosecond laser-assisted keratopigmentation for the management of visual disabilities due to peripheral iridectomies. J Glaucoma. 2015;24:e22–4.
Alio JL, Al-Shymali O, Amesty MA, Rodriguez AE. Keratopigmentation with micronised mineral pigments: complications and outcomes in a series of 234 eyes. Br J Ophthalmol. 2018;102:742–7.
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Es’haghi, A. Response to: Comment on: Keratopigmentation: a comprehensive Review. Eye 35, 355 (2021). https://doi.org/10.1038/s41433-020-0829-9
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DOI: https://doi.org/10.1038/s41433-020-0829-9