Graft blues: case report

Abstract

PurposeTo describe unusual inadvertent persistent staining of stromal structures by trypan blue (TB) after penetrating keratoplasty (PK) and Descemet membrane endothelial keratoplasty (DMEK) performed in patients suffering from lattice corneal dystrophy (LCD)MethodsCase report of patients suffering from LCD and having received intracamerular TB. Series 1: retrospective study on 85 consecutive triple procedures (PK+cataract+IOL) performed by a single surgeon (PG) in a tertiary care university hospital during 7 years. 0.4% TB was systematically used. Series 2: case report of a DMEK (stained with TB) performed after a late endothelial failure of a previous PK realized 5 years before for advanced LCD. Six weeks after DMEK, the patient was hospitalized for acute rejection that appeared unusualResultsSeries 1: Only patients with LCD (n = 18 eyes in 17 patients) presented an isolated intense blue staining of the graft host interface (blue ring). It persisted during 18‐24 months and had no consequence. Series 2: during the acute rejection, intense blue staining was observed in spindle shaped small structures located in the first third of the whole stroma. The DMEK was partially detached. Stromal edema almost completely resolved after intense steroid therapy but the stromal blue staining persisted (9 month follow‐up) with impaired vision.ConclusionsAbnormal amyloid protein characterizing LCD can be stained by TB in vivo. In PK it stains a ring in the recipient stroma and has no consequence. However, during DMEK performed after a PK, TB may also stain the protein accumulated in the graft stroma during slow recurrence of the disease. TB‐stained DMEK should therefore be avoided in late endothelial failure of a PK initially performed for LCD.