Descemet-stripping automated endothelial keratoplasty (DSAEK): effect of nontoxic gentian violet marking pen on DSAEK donor tissue viability by using vital dye assay.
OBJECTIVE
To qualitatively assess the endothelial damage on Descemet-stripping automated endothelial keratoplasty (DSAEK) donor tissue resulting from a gentian violet marking pen.


METHODS
An in vitro model was used, by using corneoscleral rims, DSAEK quality corneal donor tissue, and a gentian violet marking pen. After making a mark on the stromal side of a microkeratome-prepared DSAEK corneal button to confirm appropriate orientation of the donor tissue after insertion into the anterior chamber, the corneal tissue was returned to Optisol GS solution for 1 hour. A vital dye assay was used to identify devitalized and necrotic endothelial cells with alizarin red S and trypan blue.


RESULTS
Corneal donor tissue evaluated with the gentian violet marking pen showed positive trypan blue staining, limited to the area marked with the gentian violet ink.


CONCLUSIONS
Marking the DSAEK donor stromal surface with a gentian violet marker damages the endothelium. Surgeons should limit the size of the mark or use an insertion technique that avoids confusion about orientation of the donor cornea.
Bascom Palmer Eye Institute, Miami, FL 33136, USA.
Takeshi
T
Ide
Sonia H
SH
Yoo
George D
GD
Kymionis
Victor L
VL
Perez
James M
JM
Goldman
Terrence P
TP
O'Brien
D000880:Anthraquinones; D002470:Cell Survival / Q000187:drug effects; D004396:Coloring Agents; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000473:pathology / Q000637:transplantation*; D005840:Gentian Violet / Q000633:toxicity*; D006801:Humans; D007281:Ink; D014019:Tissue Donors; D014343:Trypan Blue
D000880:Anthraquinones; D004396:Coloring Agents; C004468:Alizarin Red S; D014343:Trypan Blue; D005840:Gentian Violet