Removal of a Cosmetic Femtosecond Laser–Assisted Keratopigmentation

Purpose: To remove the maximum amount of pigment placed in the corneal stroma in a previous cosmetic femtosecond laser–assisted keratopigmentation procedure and restore visual function. Methods: Case report. Results: A 53-year-old man presented with bilateral cosmetic femtosecond laser–assisted keratopigmentation that resulted in decreased uncorrected and corrected distance visual acuity, poor visual quality, and increased corneal aberrations. A femtosecond laser was used to create a corneal flap, followed by excimer laser ablation to remove stromal pigment within an 8.5-mm optical zone. This approach resulted in restoring corneal transparency with the regularization of corneal architecture, reduction in corneal aberrations, and elimination of induced ametropia, with subsequent improvement in visual acuity. Conclusions: In cases requiring the reversal of femtosecond laser–assisted keratopigmentation, a combined femtosecond laser and excimer laser–assisted stromal ablation may effectively remove pigment restoring corneal transparency, reduce corneal aberrations, and improve visual acuity by addressing induced refractive error.