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Purpose: To determine whether ubiquinol improves mitochondrial function and cell viability in human donor corneal endothelial cells during hypothermic corneal tissue storage., Methods: Endothelial cell Descemet membrane tissues were treated with 10 μM ubiquinol, the reduced form of the antioxidant coenzyme Q10, for 5 days in Optisol-GS storage media before assaying for mitochondrial activity using extracellular flux analysis of oxygen consumption. In addition, endothelial cell Descemet membrane tissues were analyzed for cell viability using apoptosis and necrosis assays. Control tissues from mate corneas were treated with diluent only, and comparisons were analyzed for differences., Results: A total of 13 donor corneal tissues with a mean (SEM) preservation time of 11.8 days (0.4) were included for the analysis. Treatment with 10 μM ubiquinol increased spare respiratory capacity by 174% (P = 0.001), maximal respiration by 93% (P = 0.003), and proton leak by 80% (P = 0.047) compared with controls. Cells treated with ubiquinol had no significant change in cell necrosis or apoptosis., Conclusions: Preliminary testing in donor corneal tissue at specified doses indicates that ubiquinol may be a useful biocompatible additive to hypothermic corneal storage media that increases corneal endothelial cell mitochondrial function. Additional investigations are indicated to further study and optimize the dose and formulation of ubiquinol for use in preserving donor corneal tissue function during hypothermic storage.

Purpose: 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.

Purpose: To evaluate the effect of trypan blue on the elastic property of Descemet membrane (DM) by atomic force microscopy., Methods: Human corneas (n = 10) were obtained from the Illinois Eye Bank (Chicago, IL). The DM was isolated and divided into two halves, one half was stained with ophthalmic trypan blue (Vision Blue, 0.06%, DORC International), whereas the unstained other half served as control. The DM samples were then tested using the atomic force microscope. Data were analyzed using the Hertz model for the evaluation of the Young modulus of elasticity., Results: Atomic force microscopy showed higher cantilever deflection on trypan blue-stained DM compared with control, and the difference was statistically significant (P = 0.03). Force-distance curve analysis also revealed a statistically significant increase in the Young modulus of elasticity in the trypan blue-stained samples (10.5 ± 1.4 kPa) compared with the control (5.8 ± 0.8 kPa), (P < 0.0001)., Conclusions: Our results suggest that trypan blue may decrease DM elasticity and consequently increase its stiffness. This may influence the graft adherence when used for endothelial keratoplasty.

Purpose: To describe the clinical course, ultrasonographic and confocal microscopic findings in a patient who developed a large Descemet membrane (DM) detachment that resolved spontaneously after ocular sodium cyanide injury., Methods: Case report., Results: The patient presented with severe corneal stroma edema, a large detachment of DM, iritis, and anterior subcapsular lens opacity in the left eye caused by contact with 5% sodium cyanide. The ultrasound biomicroscopic and in vivo confocal microscopic examination exhibited the configuration of the DM detachment and extensive damage of corneal cells. Although no viable endothelial cells were observed with in vivo confocal microscopy, the DM spontaneously reattached 11 days after injury, coincident with increased intraocular pressure. However, persistent corneal edema and iris atrophy were observed 6 months after DM reattached., Conclusions: Sodium cyanide can cause severe injuries to the cornea and the anterior segment. Extensive DM detachment may resolve spontaneously despite the absence of viable endothelial cells.

Purpose: To report a case of presumed bilateral corneal copper deposition secondary to oral contraceptive use., Methods: A 23-year-old woman was referred for evaluation of bilateral corneal opacities. The location of the deposits deep in Descemet's membrane and appearance made copper deposition a likely consideration., Results: Subsequent laboratory results revealed an elevated serum copper level (189 μg/dL). Other causes of cupremia were subsequently ruled out, and the patient's corneal copper deposition was attributed to her oral contraceptive use. With cessation of the oral contraceptive, her serum copper levels normalized, but the corneal deposits remained after 5 months of follow up., Conclusion: To our knowledge, we report the first case in the ophthalmic literature of presumed corneal copper deposition in the setting of oral contraceptive use. It is important to recognize the corneal findings associated with copper deposition, because it may lead to the diagnosis and treatment of other serious systemic conditions causing elevated serum copper levels.

Purpose: To report a case of Descemet membrane detachment (DMD) after cataract surgery in an operated case of deep anterior lamellar keratoplasty (DALK)., Methods: Phacoemulsification surgery with intraocular lens implantation was performed in the left eye of a 65-year-old woman who had previously undergone DALK. DMD was noted intraoperatively, for which intracameral injection of air was done at the end of surgery. On the first postoperative day, DMD was seen, and hence, intracameral 20% sulfur hexafluoride (SF(6)) gas was injected. Because the DMD did not resolve, intracameral 14% C(3)F(8) gas was injected on the seventh postoperative day., Results: At the 3-week follow-up, complete resolution of DMD was seen., Conclusions: DMD that occurs during phacoemulsification in a case that has previously undergone DALK can be effectively and safely resolved using intracameral C(3)F(8) gas injection.

Purpose: To demonstrate the effectiveness and safety of using viscoadaptive viscoelastics in deep lamellar keratoplasty (DLKP) for keratoconus., Methods: A nonrandomized, comparative, interventional case series was performed on 12 eyes of 10 consecutive keratoconus patients without a history of acute hydrops. Patients were treated with DLKP using ophthalmic viscosurgical devices (OVDs) to dissociate Descemet membrane (DM) from the stroma before suturing of the donor cornea. Eight eyes were operated using Viscoat (dispersive), and 4 eyes were operated using Healon V (viscoadaptive)., Results: Six out of 8 eyes in the Viscoat group were successfully treated, and 2 eyes were converted to PKP because of tears in the DM. Another 3 eyes had double chambers as a result of perforations or tears in DM, which were treated by injecting air into the anterior chamber. All 4 eyes in the Healon V group were successfully operated, with 1 case with microperforation of DM during suturing. Healon V offered better control of the area to be dissociated and served as a pseudostroma that protects the exposed DM while the overlying stroma is maneuvered., Conclusion: Healon V is a valuable tool for performing DLKP in difficult cases such as keratoconus.

Objective: To describe a patient who developed a Descemet membrane detachment after hydrogen peroxide injury with successful reattachment by intracameral injection of sulfur hexafluoride gas., Methods: Case report., Results: The right eye of a 40-year-old man was exposed to 35% hydrogen peroxide. This resulted in a central corneal epithelial defect, corneal edema, a localized detachment of Descemet membrane, and a gas bubble between the posterior corneal stroma and Descemet membrane. The Descemet membrane detachment persisted after reabsorption of the gas bubble. Successful reattachment of Descemet membrane was achieved with injection of 0.15 mL of 20% sulfur hexafluoride gas into the anterior chamber., Conclusion: Hydrogen peroxide ocular injury may cause Descemet membrane detachment, and successful reattachment may be achieved with intracameral injection of 20% sulfur hexafluoride gas.

A 39-year-old woman developed a painful, red eye immediately following oral surgery associated with preoperative preparation of her face with the antiseptic, Hibiclens. Epithelial and stromal edema was observed 2 weeks after surgery and progressed to diffuse bullous keratopathy. This led to penetrating keratoplasty 10 months later. Light and electron microscopic findings of the cornea included epithelial edema with bullous changes, marked loss of keratocytes, a thickened Descemet's membrane, and an attenuated, disrupted endothelial cell layer. These findings demonstrate the corneal damage that may occur following ocular exposure to Hibiclens.