title: Lutein and Brilliant Blue-Based Dye for Donor Preparation and Transplantation in Descemet Membrane Endothelial Keratoplasty.
abstract: OBJECTIVE
  Trypan blue (TB) is used for visualization of the endothelium-Descemet membrane graft during Descemet membrane endothelial keratoplasty (DMEK). However, TB is assumed to have a dose-dependent toxic effect on the corneal endothelium. We retrospectively compared a lutein/zeaxanthin and Brilliant Blue (LZ/BB)-based dye for preparation and transplantation of the graft in DMEK to TB.
  
  
  METHODS
  In 20 patients, a dye composed of 1% LZ /0.025% BB was used, and in 22 patients, 0.06% TB was used for graft visualization in DMEK. We evaluated the rebubbling rate, best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after transplantation.
  
  
  RESULTS
  Staining of endothelium-Descemet membrane with LZ/BB was faint but sufficient. There was no significant difference between both groups, except in CCT after 3 months, which was lower in the LZ/BB group (P = 0.02). In the LZ/BB group, BSCVA improved from 0.48 ± 0.39 before DMEK to 0.19 ± 0.09 after 6 months (P < 0.05) (20% rebubbling rate). Donor ECD decreased from 2735 ± 259 cells/m preoperatively to 1876 ± 316 cells/mm (P < 0.0001) at 6 months (31.4%). CCT decreased from 642 ± 130 μm preoperatively to 519.8 ± 38 μm (P < 0.0001) at 6 months. In the TB group, BSCVA improved from 0.43 ± 0.27 to 0.17 ± 0.14 (P = 0.0003) at 6 months (30% rebubbling rate). ECD decreased from 2825 ± 263 to 1777 ± 302 cells/mm (P < 0.0001) after 6 months (36.3%), CCT from 638 ± 48 μm preoperatively to 531 ± 48 μm (P < 0.0001) at 6 months.
  
  
  CONCLUSIONS
  LZ/BB-based dyes are suitable for DMEK with outcomes comparable to TB. However, available formulas result in faint staining, discouraging their routine use in donors with assumed difficult preparation.
authors.affiliation: *Department of Ophthalmology, University of Cologne, Cologne, Germany; and †Cluster of Excellence: Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebelmann
authors.forename: Mario
authors.initials: M
authors.lastname: Matthaei
authors.forename: Robert
authors.initials: R
authors.lastname: Hörster
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
authors.forename: Björn
authors.initials: B
authors.lastname: Bachmann
mesh_terms: D000368:Aged; D001557:Benzenesulfonates / Q000008:administration & dosage*; D002452:Cell Count; D004396:Coloring Agents / Q000008:administration & dosage*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D063171:Corneal Pachymetry; D003886:Descemet Membrane / Q000187:drug effects* / Q000473:pathology; D057111:Descemet Stripping Endothelial Keratoplasty; D004338:Drug Combinations; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D014975:Lutein / Q000008:administration & dosage*; D008297:Male; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D014792:Visual Acuity / Q000502:physiology; D065146:Zeaxanthins / Q000008:administration & dosage
chemical_list: D001557:Benzenesulfonates; D004396:Coloring Agents; D004338:Drug Combinations; D065146:Zeaxanthins; C006796:brilliant blue; D014975:Lutein