Klejn Alexandra, Abell Robin G
Hobart Eye Surgeons, Hobart, Tasmania, Australia.
Am J Ophthalmol Case Rep. 2024 Feb 15;34:102022. doi: 10.1016/j.ajoc.2024.102022. eCollection 2024 Jun.
This case report seeks to highlight impressive photographs of amyloid staining with trypan blue that persisted after DMEK surgery with 3 years follow-up. This has only been reported in the literature twice previously, and may have contributed to visual symptoms in the early post-operative period of this patient.
We report a case of an 82-year-old patient with concurrent Fuchs' corneal endothelial dystrophy and lattice corneal dystrophy who suffered permanent trypan blue staining of the amyloid deposits after descemet's membrane endothelial keratoplasty (DMEK) surgery.
Trypan blue staining of amyloid deposits in the corneal stroma is permanent, with research suggesting potential stimulation of progression or recurrence of amlyoid deposition. This is relevant for all anterior segment surgeons using trypan blue in the setting of primary (eg. lattice corneal dystrophy) or secondary amyloid deposition (eg. polymorphous amyloid degeneration, chronic inflammation, systemic disease). Trypan blue staining should be limited or alternative surgical options such as descemet's stripping automated endothelial keratoplasty (DSAEK) considered.
本病例报告旨在展示在进行 Descemet 膜内皮角膜移植术（DMEK）后3年随访期间，锥虫蓝淀粉样蛋白染色的令人印象深刻的照片。此前该情况在文献中仅被报道过两次，并且可能是该患者术后早期出现视觉症状的原因。
我们报告了一例82岁患者，同时患有富克斯角膜内皮营养不良和格子状角膜营养不良，在 Descemet 膜内皮角膜移植术（DMEK）后，淀粉样蛋白沉积物出现了永久性锥虫蓝染色。
角膜基质中淀粉样蛋白沉积物的锥虫蓝染色是永久性的，研究表明这可能会刺激淀粉样蛋白沉积的进展或复发。这对于所有在原发性（如格子状角膜营养不良）或继发性淀粉样蛋白沉积（如多形性淀粉样变性、慢性炎症、全身性疾病）情况下使用锥虫蓝的眼前节外科医生来说都很重要。应限制锥虫蓝染色或考虑选择其他手术方式，如 Descemet 膜剥脱自动内皮角膜移植术（DSAEK）。
