Transplantation Blues: Inadvertent Staining of Amyloid Deposits With Trypan Blue
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Titre | Transplantation Blues: Inadvertent Staining of Amyloid Deposits With Trypan Blue |
Type de publication | Journal Article |
Year of Publication | 2018 |
Auteurs | Marcon A, Perillat N, Garcin T, Jullienne R, He Z, Forest F, Gauthier ASophie, Gain P, Thuret G |
Journal | CORNEA |
Volume | 37 |
Pagination | 824-828 |
Date Published | JUL |
Type of Article | Article |
ISSN | 0277-3740 |
Mots-clés | amyloid, Keratoplasty, lattice corneal dystrophy, trypan blue |
Résumé | Purpose: To describe inadvertent persistent staining of stromal amyloid deposits by trypan blue (TB) after penetrating keratoplasty (PK) and Descemet membrane endothelial keratoplasty (DMEK) performed in patients with corneal amyloidosis. Methods: Case series of patients with corneal amyloidosis in whom intraoperative TB was used. Results: One patient, hospitalized for acute rejection 6 weeks after DMEK, presented with an intense blue staining of small, spindle-shaped structures in the anterior half of the cornea. DMEK had been performed for endothelial failure of a previous PK procedure done 13 years earlier for advanced lattice corneal dystrophy (LCD). After 6 months, the stromal blue tattoo persisted with impaired visual acuity, and PK was performed. Blue-stained structures were amyloid deposits characteristic of LCD recurrence. In parallel, among 85 consecutive triple procedures (PK + cataract + intraocular lens [IOL]) performed over 7 years, in which TB was used, only patients with LCD (n = 18 eyes in 17 patients) or presumed secondary amyloidosis due to chronic inflammation (n = 1), presented an isolated intense blue ring of the graft-host interface. This persisted up to 7 years with no clinical consequence. Conclusions: TB can stain corneal amyloid deposits. After PK, staining is limited to the recipient peripheral cornea and has no apparent clinical consequence. However, during DMEK performed after a failed PK, TB stains fibrils accumulated during slow LCD recurrence and scattered on the whole graft. The long-term staining duration indicates strong interactions between TB and amyloid. |
DOI | 10.1097/ICO.0000000000001591 |