Dye-based identification of the orientation of tissue for Descemet stripping automated endothelial keratoplasty: A laboratory-based study

Abstract

Purpose: To describe the features enabling the identification of the orientation of Descemet stripping automated endothelial keratoplasty (DSAEK) lenticule with the assistance of vital dyes. Methods: This is a blinded experimental lab-based study, including 30 microkeratome prepared precut DSAEK lenticules. The lenticules were divided into control and study arms which included 10 unstained and 20 stained lenticules, respectively. In the study arm, vital dyes like trypan blue (TB), brilliant blue (BB), indocyanine green (ICG) and fluorescein stain (FS) were used to stain 5 lenticules each. They were examined by experienced (group 1) and novice surgeons (group 2) to identify the correct orientation of the lenticule. The results were tabulated and analyzed. Results: Of the 30 lenticules examined, the average of total scores obtained by each observer was higher (78%) in group 1 as compared to group 2 (65.3%) which was statistically significant ( P < 0.005). In group 1, the accuracy of identifying the correct orientation of unstained lenticules was 70% which improved to 82% on staining. The accuracy in group 2 was 58% with unstained lenticules which improved to 69% on staining. Within the study arm, irrespective of surgical experience, the accuracy was highest with BB (86%), followed by TB (82%), ICG (72%) and FS (62%). Conclusion: This study found that the accuracy of identifying the orientation of DSAEK lenticules increased with experience and with the assistance of staining using vital dyes. This accuracy improved with blue dyes like brilliant blue and trypan blue, irrespective of the level of experience.

Gentian violet (GV) ink associated reaction in a case of preloaded Descemet membrane endothelial keratoplasty: Case report

“…The effect of 0.01 % and 0.001 % GV staining on the cornea is reported to be safe, with no toxic effects. 3 However, significant GV cytotoxicity was observed at 0.10 % or higher concentrations. 4 …”

“…Various vital stains are used for marking, and their safety has been established at low concentrations. 3 …”

Toxicidad por marcador corneal en Femto-LASIK. Reporte de caso

“…En los últimos años este colorante se ha utilizado en marcadores para procedimientos en ortopedia, cirugía plástica, cirugía cardiovascular, dermatología y neurología, reemplazando al azul de metileno que se utilizaba en la década los años 90 3 . En oftalmología, se utilizan marcadores de tinta compuesta de violeta de genciana para delimitar el tejido ocular, permitiendo mantener la orientación del tejido corneal trasplantando (DSAEK-Trasplante endotelial), del colgajo corneal en cirugía refractiva (LASIK) o del lente intraocular tórico (cirugía de catarata) 4,5 .…”