Use of trypan blue dye during conversion of deep anterior lamellar keratoplasty to penetrating keratoplasty

Abstract

We describe a technique that uses trypan blue dye to identify residual recipient corneal stroma and Descemet membrane (DM) during conversion of deep anterior lamellar keratoplasty (DALK) to penetrating keratoplasty (PKP). After the host cornea is dissected, trypan blue dye (0.06%) is used to highlight the remaining host corneal stroma and DM, if any. In 8 DALK procedures that had to be converted to PKP because of DM perforation, trypan blue staining identified remnants of DM and parts of the posterior corneal stroma in 7 eyes. Improved visualization of the residual host tissue enabled complete excision and an overall optimal recipient wound profile.

Donor-Recipient Crosslinking-Assisted Manual Deep Anterior Lamellar Keratoplasty: DRXL-DALK

“…In some cases, it is possible to create mixed-bubbles; in this case, according to some authors, it is recommended to open the type 1 bubble and leave the type 2 bubble intact [13,14]. The mixed-bubble can be solved with greater safety by moistening the residual stroma for several minutes using trypan blue to highlight the residual stroma which takes on a bluish colour, while the DM will remain transparent [15,16]. Moreover, by colouring the stroma we better remove any stromal residues from the type 1 bubble [1].…”

Corneal surgery in keratoconus: which type, which technique, which outcomes?

“…Depending on the size of the perforation, conversion to PK may be required to avoid double anterior chamber and persistent corneal edema, especially when the rupture leads to the collapse of the anterior chamber (macroperforation). Incidence of pseudo anterior chamber or double anterior chamber is in the range of 1 % [ 56 ]. It can occur because of retention of fluid secondary to breaks in the DM or because of incomplete removal of viscoelastic in the interface [ 57 ].…”

Component corneal surgery: An update

“…Pseudoanterior chamber, also referred as double anterior chamber or interface fluid, can be due to retention of fluid as a consequence of DM perforation or retention of viscoelastic. [ 54 55 ] The reported incidence is <1%. [ 21 ] Although a shallow pseudochamber can be observed, a large pseudochamber requires surgical intervention in the form of drainage of fluid and intracameral injection of air or gas.…”

“…[ 21 ] Although a shallow pseudochamber can be observed, a large pseudochamber requires surgical intervention in the form of drainage of fluid and intracameral injection of air or gas. [ 54 55 ]…”