Specular Microscopic Imaging Results May Be Deceiving, as Demonstrated by Vital Dye Staining

Authors

Hisham A. Saad, MD, Christopher Stoeger, CEBT

Keywords

endothelial keratoplasty, microkeratome, vital stain, slit lamp, specular microscopy

Abstract

PURPOSE: To describe a case where specular microscopy data relayed misleading information regarding the quality of a cornea processed in an eye bank for endothelial keratoplasty.

METHODS: A cornea was prepared by microkeratome for endothelial keratoplasty and was evaluated with routine slit lamp and specular microscopy. In addition, the tissue was stained with trypan blue and alizarin red S to demonstrate the efficacy of the preliminary evaluation with endothelial viability studies. The stained cornea was photographed, and the percent cell death was calculated using Adobe Photoshop analysis.

RESULTS: The preresection central endothelial cell density was 2608 cells/mm². In comparison, the post-cut density was 2978 cells/mm², a figure that represents a 14.19% cell gain. Viability staining with analysis showed 43.77% cell damage.

CONCLUSIONS: Reliance on specular microscopy for determination of endothelial viability can lead to misleading conclusions, as demonstrated in this case study.

doi:10.7706/ijeb.v1i2.27

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