Abstract ID: 26-150
Femtosecond Laser–Assisted Keratopigmentation as an Alternative to Evisceration in Pediatric Phthisis Bulbi.
Author: Marta Mifsut Aleixandre Base Hospital / Institution: Vissum Alicante
Presentation Type: ePoster Presentation
Purpose
Femtosecond laser–assisted keratopigmentation (FS-KTP) has emerged as a minimally invasive technique for the aesthetic rehabilitation of non-functional eyes. In pediatric patients with phthisis bulbi, it offers a conservative alternative to more aggressive procedures such as evisceration, preserving ocular anatomy, orbital dynamics, and psychological well-being.
Methods
We report the case of a 13-year-old male with bilateral blindness secondary to stage 5 retinopathy of prematurity. The right eye exhibited phthisis bulbi confirmed by ultrasonography, with a disorganized anterior segment. The left eye presented with a white cataract and chronic retinal detachment. Visual acuity in both eyes was no light perception (NLP). Associated findings included nystagmus, neovascularization, and lipid keratopathy. Given the significant psychosocial impact, aesthetic rehabilitation was pursued.
Results
The primary therapeutic dilemma involved choosing between evisceration with prosthetic implantation and FS-KTP. The latter offers several advantages, including reduced invasiveness, preservation of orbital volume, improved ocular motility (particularly relevant in the presence of nystagmus), and a lower psychological burden. The technique involves the creation of intrastromal tunnels using a femtosecond laser, followed by the injection of mineral pigments, resulting in a stable cosmetic outcome. Experimental studies have demonstrated high biocompatibility, with no evidence of inflammation or pigment migration. However, potential limitations include photophobia, intraoperative challenges related to corneal opacity, and variability in aesthetic results.
Conclusion
FS-KTP is a safe and effective option for aesthetic rehabilitation in pediatric non-functional eyes. It avoids disfiguring surgery, preserves anatomical and psychological integrity, and provides long-term stability using inert pigments within a closed stromal pocket. Evisceration should not be the first option when globe-preserving alternatives exist.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Maria Alejandra | Amesty | Vissum Alicante |
| Mariam | Davitashvili | Vissum Alicante |