"I Am Seeing Blue Spots In My Vision"

Vision blue is a safe dye and is commonly used. Firstly it is used to optimise visualisation of donor DMEK tissue and secondly it is used intracamerally after a descemeto-rhexis is performed to ensure no residual tags of Descemet's membrane remain.

Singleton Hospital, Swansea, Wales, UK.

A 77-year-old female with bilateral pseudophakia and Fuchs’ endothelial dystrophy underwent a left uncomplicated Descemet’s membrane endothelial keratoplasty (DMEK) on 20/2/2024. Intraoperatively, vision blue dye was used to visualize the 7.75mm donor graft and ensure no residual Descemet’s membrane tags remained. Pre-operatively, her best-corrected visual acuity (BCVA) was 0.76, improving to 0.50 nearly a year post-op. Despite the improvement, she reported persistent blue spots and slight blur, declining further intervention. Vision blue staining at the interface between the host stroma and donor graft, noted one-week post-op, persisted at one year. Vision blue is commonly used and generally safe, with only six reported cases of persistent trypan blue stromal staining, four post-cataract surgery and two post-DMEK, mostly in patients with lattice corneal dystrophy [1-3]. 

This case is a world first documented instance of persistent symptomatic vision blue staining post-DMEK in a patient without lattice stromal dystrophy.

References:

1 - Farooq AV, Tu EY, D'jalilian AR, Traish AS, Hou JH. Persistent staining of lattice lines after intraoperative trypan blue use in patients with lattice corneal dystrophy. Cornea. 2014 Nov;33(11):1235-7.

2- Jhanji V, Agarwal T, Titiyal JS. Inadvertent corneal stromal staining by trypan blue during cataract surgery. J Cataract Refract Surg. 2008 Jan;34(1):161-2.

3 - Pereira A, Boutin T, Rootman DS, Chan CC. Inadvertent corneal stromal staining by trypan blue following Descemet's membrane endothelial keratoplasty. Can J Ophthalmol. 2019 Aug;54(4):e174-e175