Transplantation Blues: Inadvertent Staining of Amyloid Deposits With Trypan Blue.

Abstract

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.

• Authors: Agathe Marcon, Nicolas Périllat, Thibaud Garcin, Rémy Jullienne, Zhiguo He, Fabien Forest, Anne Sophie Gauthier, Philippe Gain, Gilles Thuret
• Journal: Cornea (Cornea) Vol. 37 Issue 7 Pg. 824-828 (Jul 2018) ISSN: 1536-4798 [Electronic] United States
• PMID: 29595762 (Publication Type: Journal Article)

Chemical References

• Coloring Agents
• Trypan Blue

Topics

• Adult
• Amyloidosis, Familial (surgery)
• Coloring Agents (adverse effects)
• Cornea (pathology)
• Corneal Dystrophies, Hereditary (surgery)
• Descemet Stripping Endothelial Keratoplasty (adverse effects, methods)
• Female
• Graft Rejection (chemically induced)
• Humans
• Keratoplasty, Penetrating (adverse effects, methods)
• Male
• Middle Aged
• Plaque, Amyloid (pathology)
• Retrospective Studies
• Trypan Blue (adverse effects)