Endothelialectomy With Trypan Blue Staining to Enhance Descemetorhexis Visualization

To describe a technique involving combined endothelialectomy and trypan blue staining to allow for improved visualization and Descemet membrane (DM) removal during endothelial keratoplasty.

Endothelialectomy with 2 disposable endothelial irrigating cannulas (Vortex and Sterimedix) and an irrigation-aspiration handpiece are described. Several passes over the desired area are made to ensure adequate endothelialectomy treatment. Trypan blue is instilled into the anterior chamber, and after irrigation, the trypan stains the exposed DM, which enhances visualization. Subsequently, one's standard technique for descemetorhexis can then be performed.

Endothelialectomy with trypan blue staining was performed in 9 eyes and was able to successfully enhance visualization of DM in all cases. The technique easily allowed for visualization of the descemetorhexis edge despite the poor view. Although all 3 instruments for endothelialectomy allowed for successful descemetorhexis, the Vortex endothelial cannula provided more complete and consistent endothelialectomy with fewer passes. The descemetorhexis tissue from 1 case using the Sterimedix cannula was sent for histological review and demonstrated a paucity of endothelial cells, intact DM, and blunted guttae.

Targeted endothelialectomy and trypan blue staining can be a useful technique to enhance visualization during endothelial keratoplasty. This can allow for a more complete descemetorhexis in areas with marginal visibility.