Retained interface gentian violet ink in Descemet stripping endothelial keratoplasty

Abstract

Purpose: To present a case of a patient who underwent right Descemet stripping endothelial keratoplasty (DSEK) in whom the gentian violet ink used to mark and orient the donor corneal graft had persisted at the host-graft interface. Methods: A 57-year-old woman with progressive corneal edema from Fuchs endothelial dystrophy in her right eye underwent a combined phacoemulsification/posterior chamber intraocular lens insertion and DSEK. The host endothelium was stripped in a central 9.0-mm diameter. The endothelial graft was harvested to a depth of 400 mm. The anterior stromal flap was lifted, and the stromal side of the endothelial graft was peripherally marked with a dotted "7" using a Codman gentian violet marker pen and a dot was placed at the center to aid centration. The graft was inserted and centrally positioned. The superior clear corneal wound was closed with 3 × 10/0 nylon interrupted sutures. The patient was instructed to lie face up for the first 48 hours. Results: At 1 week, the graft was well positioned and the central gentian violet mark was not present but the peripheral markings were noted. At 14 months, the cornea was clear with an unaided visual acuity of 20/25 and best-corrected visual acuity of 20/20 but the superior peripheral markings persisted at the graft-host interface. Specular microscopy demonstrated a cell density of 1900 cells per square millimeter. Conclusions: Gentian violet ink marking used in DSEK operations may persist at the graft-host interface. Small, peripheral markings will minimize the risk of interference with central vision, ink-induced inflammation, and endothelial damage.