Corneal amyloid staining after trypan blue in Descemet's membrane endothelial keratoplasty

This case report seeks to highlight impressive photographs of amyloid staining with trypan blue that persisted after DMEK surgery with 3 years follow-up. This has only been reported in the literature twice previously, and may have contributed to visual symptoms in the early post-operative period of this patient.

We report a case of an 82-year-old patient with concurrent Fuchs' corneal endothelial dystrophy and lattice corneal dystrophy who suffered permanent trypan blue staining of the amyloid deposits after descemet's membrane endothelial keratoplasty (DMEK) surgery.

Trypan blue staining of amyloid deposits in the corneal stroma is permanent, with research suggesting potential stimulation of progression or recurrence of amlyoid deposition. This is relevant for all anterior segment surgeons using trypan blue in the setting of primary (eg. lattice corneal dystrophy) or secondary amyloid deposition (eg. polymorphous amyloid degeneration, chronic inflammation, systemic disease). Trypan blue staining should be limited or alternative surgical options such as descemet's stripping automated endothelial keratoplasty (DSAEK) considered.