The “Polish Sign”: A Novel Intraoperative Visual Indicator During Descemet’S Membrane Polishing In Cultured Human Corneal Endothelial Cell Injection Therapy
Published 2026 - 44th Congress of the ESCRS
Reference: PP11.15 | Type: Free paper | DOI: 10.82333/05eg-rr64
Authors: Dr Akira Kobayashi* 1 , A/Prof. Takefumi Yamaguchi 2 , Dr Seiichiro Sugita 3 , Dr Natsuko Mori 1 , Dr Hideaki Yokogawa 1 , Dr Yukari Yagi-Yaguchi 2 , A/Prof. Tomomi Higashide 1
1Department of Ophthalmology,Kanazawa University Hospital,Kanazawa,Japan, 2Department of Ophthalmology,Tokyo Dental College, Ichikawa General Hospital,Ichikawa,Japan, 3Department of Ophthalmology,Sugita Eye Hospital,Nagoya,Japan
Purpose
To describe a novel intraoperative visual indicator, the “polish sign,” which facilitates safe and controlled Descemet’s membrane (DM) polishing during cultured human corneal endothelial cell (cHCEC; Vyznova®) injection therapy for bullous keratopathy.
Setting
Multicenter observational study conducted at three tertiary referral centers in Japan.
Methods
Thirty-two consecutive eyes with bullous keratopathy underwent cHCEC injection therapy. Following a 1.2-mm limbal incision, the central DM within an approximately 8-mm zone was gently polished using a Kinoshita-type DM polisher with a silicone-covered tip allowing coaxial irrigation. The polish sign, defined as a transient whitish discoloration at the point of silicone–DM contact, was evaluated intraoperatively. Adequacy of endothelial removal was confirmed using trypan blue staining, and absence of DM detachment was verified by anterior segment optical coherence tomography. Ex vivo validation was performed in porcine eyes (n = 3) obtained from a commercial abattoir using identical settings.
Results
The polish sign was consistently observed in all 32 eyes (100%), either intraoperatively or upon video review. Polishing was completed in all cases without DM rupture or detachment. The sign remained identifiable even in eyes with stromal haze, although reduced visibility required oblique slit illumination. Intraoperative trypan blue staining confirmed adequate endothelial removal in all cases. The phenomenon was reproducible across different microscope platforms and institutions. In porcine experiments, a similar transient whitening was observed in all three eyes, although less pronounced than in human bullous keratopathy cases.
Conclusions
The polish sign provides a simple, reproducible, real-time indicator of adequate DM polishing while minimizing the risk of membrane injury. Recognition of this intraoperative visual cue may enhance procedural safety and reproducibility in endothelial cell–based therapies.