Specular Microscopic Imaging Results May Be Deceiving, as Demonstrated by Vital Dye Staining

PURPOSE: To describe a case where specular microscopy data relayed misleading information regarding the quality of a cornea processed in an eye bank for endothelial keratoplasty. METHODS: A cornea was prepared by microkeratome for endothelial keratoplasty and was evaluated with routine slit lamp and specular microscopy. In addition, the tissue was stained with trypan blue and alizarin red S to demonstrate the efficacy of the preliminary evaluation with endothelial viability studies. The stained cornea was photographed, and the percent cell death was calculated using Adobe Photoshop analysis. RESULTS: The preresection central endothelial cell density was 2608 cells/mm 2 . In comparison, the post-cut density was 2978 cells/mm 2 , a figure that represents a 14.19% cell gain. Viability staining with analysis showed 43.77% cell damage. CONCLUSIONS: Reliance on specular microscopy for determination of endothelial viability can lead to misleading conclusions, as demonstrated in this case study. doi:10.7706/ijeb.v1i2.27

[1]  M. Terry,et al.  Peripheral Endothelial Cell Damage After Trephination of Donor Tissue , 2009, Cornea.

[2]  Christopher G. Stoeger,et al.  Endothelial Keratoplasty: The Influence of Insertion Techniques and Incision Size on Donor Endothelial Survival , 2009, Cornea.

[3]  Christopher G. Stoeger,et al.  An Easy and Inexpensive Method for Quantitative Analysis of Endothelial Damage by Using Vital Dye Staining and Adobe Photoshop Software , 2008, Cornea.

[4]  F. Price,et al.  Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue. , 2006, Ophthalmology.

[5]  Marianne O Price,et al.  Descemet's stripping with endothelial keratoplasty in 200 eyes: Early challenges and techniques to enhance donor adherence , 2006, Journal of cataract and refractive surgery.

[6]  P. Padmanabhan,et al.  Initial results of small incision deep lamellar endothelial keratoplasty (DLEK). , 2006, American journal of ophthalmology.

[7]  M. Terry,et al.  Deep lamellar endothelial keratoplasty visual acuity, astigmatism, and endothelial survival in a large prospective series. , 2005, Ophthalmology.

[8]  M. Terry,et al.  Stability of vision, topography, and endothelial cell density from 1 year to 2 years after deep lamellar endothelial keratoplasty surgery. , 2005, Ophthalmology.

[9]  P. Mulder,et al.  Endothelial cell density after posterior lamellar keratoplasty (Melles techniques): 3 years follow-up. , 2004, American journal of ophthalmology.

[10]  R. H. Wijdh,et al.  A Technique to Excise the Descemet Membrane From a Recipient Cornea (Descemetorhexis) , 2004, Cornea.

[11]  G. Melles,et al.  Sutureless, Posterior Lamellar Keratoplasty: A Case Report of a Modified Technique. , 2002, Cornea.

[12]  U. Stenevi,et al.  Visual outcome in corneal grafts: a preliminary analysis of the Swedish Corneal Transplant Register , 2002, The British journal of ophthalmology.

[13]  E. Pels,et al.  A surgical technique for posterior lamellar keratoplasty. , 1998, Cornea.

[14]  E. Cohen,et al.  Triple vs nonsimultaneous procedures in Fuchs' dystrophy and cataract. , 1996, Archives of ophthalmology.

[15]  M. Taylor,et al.  Dual staining of corneal endothelium with trypan blue and alizarin red S: importance of pH for the dye-lake reaction. , 1981, The British journal of ophthalmology.

[16]  G. Peyman,et al.  A new technique for the vital staining of the corneal endothelium. , 1976, Investigative ophthalmology.