Endothelialectomy With Trypan Blue Staining to Enhance Descemetorhexis Visualization

Area of Science:

• Ophthalmology
• Surgical Techniques
• Corneal Transplantation

Background:

• Endothelial keratoplasty is a common procedure for corneal endothelial dysfunction.
• Visualization and removal of Descemet membrane (DM) can be challenging during the surgery.
• Improved techniques are needed to enhance surgical precision and outcomes.

Purpose of the Study:

• To describe a novel technique combining endothelialectomy and trypan blue staining.
• To evaluate the effectiveness of this combined approach for improved visualization and DM removal during endothelial keratoplasty.

Main Methods:

• Endothelialectomy was performed using disposable endothelial irrigating cannulas (Vortex and Sterimedix) and an irrigation-aspiration handpiece.
• Trypan blue was instilled into the anterior chamber to stain the exposed DM, enhancing visualization.
• Standard descemetorhexis techniques were then applied.

Main Results:

• The combined technique successfully enhanced DM visualization in all 9 eyes studied.
• The Vortex cannula provided more complete and consistent endothelialectomy with fewer passes compared to other instruments.
• Histological review of tissue from one case showed intact DM with a paucity of endothelial cells.

Conclusions:

• Targeted endothelialectomy with trypan blue staining is a valuable technique for improving visualization during endothelial keratoplasty.
• This method facilitates a more complete descemetorhexis, especially in areas with limited visibility.