Blue Ring Technique for Clearer Visualization of Incision Line During Corneal Transplantation

Abstract

Objectives: A novel surgical technique that improves visualization of wound margins during deep anterior lamellar keratoplasty (DALK) and challenging cases of penetrating keratoplasty (PK) is described.Methods: The standard keratoplasty technique was modified to allow better visualization of wound margins. After trephination of the cornea, the wound is opened with the help of an anterior chamber cannula, the margins are stained with trypan blue, and then washed with balanced salt solution. Only the stroma that is incised will be stained with the dye, while the healthy corneal epithelium remains unstained. The corneal button is removed by following the blue ring. Next, the corneal graft tissues are sutured to the recipient bed. At this step, the colored line allows for better visualization of the margins and the depth of the sutures.Results: This technique is useful in all cases of DALK and PK. It is especially helpful in cases with corneal scars, which can lead to incomplete trephination. In such cases, the surgeon can easily follow the blue ring while making a manual incision. This technique both allows the surgeon to save time during these relatively complex surgeries and allows for the formation of a nice, round recipient bed.Conclusion: This technique has the potential to increase surgical comfort and reduce irregularities in the recipient bed that have the potential to cause irregular astigmatism