Combined staining of corneal endothelium by alizarine red and trypane blue

Quantitative analysis of cornea endothelial cell damage from enucleation, corneal buttoning, and storage in donor corneas using trypan blue dye staining

We aimed to quantitatively analyze the corneal endothelial cell damage by measuring the area stained with trypan blue dye, and to confirm the degree of corneal endothelial cell damage resulting from enucleation, corneal buttoning, and storage in donor corneas intended for use in human corneal transplantation. This study was a retrospective analysis of medical records and videos recorded during keratoplasty. Twenty-one corneal buttons of 21 donors that underwent endothelial cell staining using trypan blue for the donor preparation during DALK or DMEK were included in the study. The percentage of stained area in entire corneal endothelia and the percentage of the stained area in the 8-mm diameter circle were quantitatively analyzed using Adobe Photoshop. The mean percentage of the stained area in the entire corneal endothelia in 13 corneas was 8.1 ± 13.3% (range, 0.0-56.1%), and the mean percentage of the stained area in a circle with a diameter of 8 mm in 21 corneas was 3.4 ± 5.2% (range, 0.0-18.9%). The correlations between the death-to-preservation time, the training duration of the residents who performed donor corneal buttoning, and the percentage of the stained area in the 8-mm diameter circle were not significant(P = .441, P = .495, respectively). Cornea thickness and endothelial cell density did not differ between 10 eyes in the group with the percentage of the stained area in a circle with a diameter of 8 mm <5% and 5 eyes in the group with the percentage more than 5% damage (P = .854, P = .358). The corneal endothelial cell damage could be quantitatively analyzed using trypan blue staining before keratoplasty in donor cornea. The amount of corneal endothelial cell damage in the central 8-mm circle was mostly acceptable, but some cases showed significantly severe endothelial cell damage. The corneal thickness and endothelial cell density did not differ between 10 eyes in the group with the percentage of the stained area in a circle with a diameter of 8 mm <5% and 5 eyes in the group with the percentage more than 5% damage. Therefore, pachymetry and specular microscopy are not sufficient for evaluating donor corneas before keratoplasty.

Effects of Perfluorobutylpentane (F4H5) on Corneal Endothelial Cells

Purpose: To evaluate the effects of perfluorobutylpentane (F4H5) on corneal endothelial cell density (ECD) and morphology using a porcine corneal endothelial organ culture model. Materials and methods: "Split corneal buttons" were cultivated for 15 days (d) after incubation in F4H5 (15, 30, 60, and 120 min) or BSS (controls). ECD was assessed manually on d1, d8, and d15. After histological staining (trypan blue, alizarin red S) on d15 morphological changes (reformation figures, rosette formations, and alizarin red cells) were evaluated. Results: ECD was significantly reduced after incubation in F4H5 for 120 min (median ± 25%/75%-quartile; 3281 ± 43/222 cells/mm²; p = 0.046) on d15 compared to controls (3658 ± 129/296 cells/mm²), but not after shorter incubation times (15, 30, and 60 min). Morphological assessment supports these findings as reformation figures (F4H5 120 min: 10.5 ± 9.3/13.9/mm² vs. controls: 5.2 ± 2.8/7.2/mm²; p = 0.010), rosette formations (F4H5 120 min 25.566 ± 17.044/36.219/mm² vs. controls: 8.333 ± 0.000/15.667/mm²; p = 0.002), and alizarin red cells (F4H5 120 min: 38.350 ± 29.827/51.333/mm² vs. controls: 20.833 ± 10.417/25.000/mm²; p = 0.049) were significantly more prevalent after incubation in F4H5 for 120 min compared to controls. Also, F4H5 60 min showed significantly more rosette formations (25.452 ± 16.968/36.057/mm²; p = 0.006) and alizarin red cells (46.662 ± 42.420/50.903/mm²; p = 0.007), but not reformation figures (7.0 ± 2.2/1.6 %; p = 0.953). Conclusion: Short exposure (≤30 min) of porcine corneal endothelial cells to F4H5 does not have significant effects on ECD or morphological characteristics. Longer exposure times (≥60-120 min) may cause ECD decline and/or induce morphological changes.

Effects of argon laser iridotomy on the corneal endothelium of pigmented rabbit eyes

Purpose

In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium.

Methods

Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy.

Results

Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy.

Conclusions

Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.

Organ culture, but not hypothermic storage, facilitates the repair of the corneal endothelium following mechanical damage

PURPOSE

To evaluate the reparative capacity of the mechanically injured endothelium of corneas stored under organ culture (OC) or hypothermic conditions.

METHODS

The central endothelium of 12 pairs of human corneas with similar endothelial parameters was damaged to create a 1 mm(2) lesion. One cornea from each pair was stored under OC and one under hypothermic conditions. The endothelial cell density (ECD), coefficient of variation, hexagonality and percentage of dead cells were assessed before and after damage and on days 7, 14, 21 and 28 of storage.

RESULTS

The mean ECD of corneas subsequently stored under OC or hypothermic conditions was 2764/mm(2). Immediately after damage, a denuded Descemet's membrane with a few remaining dead cells was observed at the injured area. After 7 days of storage under OC conditions, almost no dead cells were observed at the place of injury. A non-significant worsening of the qualitative parameters (polymegatism and pleomorphism) was found. After 14 days, ECD was 1933/mm(2) and 2478/mm(2) centrally and pericentrally, respectively. Similar values were found after 21 and 28 days of storage. The lesions with remnant dead cells persisted throughout hypothermic preservation. From day 14 the corneas became cloudy and in poor condition, while the pericentral ECD was 2523/mm(2).

CONCLUSION

The reparative capacity of the cornea is maintained under OC but not under hypothermic conditions. For corneas containing dead endothelial cells, OC is therefore the method of choice because it may improve the quality of the stored tissue.

Corneal endothelial protection by heparin and sodium hyaluronate surface coating of PMMA intraocular lenses

Protective effect on corneal endothelium from surface modification of PMMA intraocular lenses were evaluated. Sodium hyaluronate, heparin or both were covalently bound to the PMMA surface rendering it hydrophilic. Endothelial damage was evaluated by placing the intraocular lens optics on the endothelial surface of excised rabbit corneas. The type and extent of endothelial cell damage was evaluated by light microscopy after alizarine red/trypan blue staining and by scanning electron microscopy. The number of endothelial cells attached to the intraocular lens surface was counted in the light microscope after staining with haematoxylin--eosine. Significantly less damage (p less than 0.05) to the endothelium was caused by the surface modified hydrophilic intraocular lenses. There was no difference between the various types of surface coatings studied in this investigation.

The surface coat on human corneal endothelium

Scanning electron microscopy of human cadaver corneas revealed a selective binding of ruthenium red-osmium tetroxide to some substance coating the posterior endothelial surface. A coating material was not found on autolyzed cells, on denuded areas of the membrane of Descemet, or on the anterior surface of endothelial cells. Partial digestion of the coating material by urokinase and trypsin suggests the presence of at least three different structural or chemical elements.

Corneal endothelial integrity in aging mice lacking superoxide dismutase-1 and/or superoxide dismutase-3

PURPOSE

To evaluate the age-induced changes in corneal endothelial morphology in mice lacking the cytosolic copper-zinc superoxide dismutase (SOD-1), the interstitial extracellular superoxide dismutase (SOD-3), or both of these SOD isoenzymes.

METHODS

The central corneal endothelial morphologies of old C57BL-6J wild type (n=19), SOD-1 null (n=16), SOD-3 null (n=15), and SOD1/3 null (n=11) mice were evaluated using alizarin red staining and light microscope photographs. For comparison, young endothelia from the same genotypes were evaluated similarly. The levels of corneal reactive oxygen species and nitrogen species in all four genotypes were quantified using fluorimetry with 2',7'-dichlorodihydrofluorescein diacetate and OxyBURST.

RESULTS

In accordance with our previous findings, the mean corneal endothelial cell area was larger in the SOD-3 null genotype than in the wild type mice. The SOD-1/3 null genotype had similar cell sizes as the SOD-3 null mice but had a more irregular morphology at an older age. Apparently, these irregularities develop with time as they are not seen in young animals. The SOD-1 null mice did not differ from the wild type mice in corneal endothelial morphology. Elevated levels of reactive oxygen species were seen in SOD-1 null and SOD-3 null corneas, and elevated superoxide levels were seen in all three knockout genotypes.

CONCLUSIONS

The increased spontaneous age-related enlargement of corneal endothelial cells seen in the absence of SOD-3 is associated with a more irregular cell pattern when combined with a lack of SOD-1. This indicates more cellular movements and ongoing repair in the SOD-1/3 null genotype and possibly a more vulnerable corneal endothelium. SOD-3 and SOD-1 appear to have functions in preserving corneal endothelial integrity in aging.

Corneal endothelial injury thresholds for exposures to 1.54 micro m radiation

The endothelial injury threshold was determined in rabbit for an 11-s exposure to 1.54 micro m radiation from an Erbium fiber laser. The beam was Gaussian with a 1/e diameter of 7 mm. Cell damage was detected with a wet staining technique. The threshold dose for these conditions is 4.4 x 10(5) J m(-2) (44 J cm) and is only 9% greater than the threshold for epithelial damage for the same exposure conditions. Exposures just above the threshold caused substantial endothelial damage, including loss of cells. The calculated endothelial temperature increase at the threshold is similar to that calculated for the epithelium at its injury threshold for the same exposure conditions. The results suggest that endothelial damage can be correlated with a critical temperature damage model with a critical temperature increase near 40 degrees C. The results also suggest that if a person were to receive an exposure only slightly above the epithelial injury threshold from a beam having a diameter of 7 mm (which is the diameter of the exit pupil of 7 x 50 binoculars) he or she would risk sustaining substantial endothelial damage.

Use of trypan blue for penetrating keratoplasty

Use of trypan blue for penetrating keratoplasty was developed to facilitate the procedure. Trypan blue is injected before and after the addition of 0.25 mL of an ophthalmic viscosurgical device (OVD), sodium hyaluronate, to stain the internal and external cut edge of the cornea as well as the OVD, enabling the surgeon to improve visualization of the incision and suture depth, improve alignment of host and donor tissues, and ensure that all OVD is removed.

Corneal Endothelial Cell Damage After Experimental Diode Laser Thermal Keratoplasty

PURPOSE

To evaluate the safety of diode laser thermal keratoplasty (LTK) with respect to corneal endothelial cell damage.

METHODS

In an in vitro animal model system, porcine eyes were irradiated with a continuously emitting laser diode at wavelengths (lambda) of 1.85 or 1.87 microm, corresponding to an absorption coefficient (micro(a)) of 1.1 or 2.0 mm(-1). Different irradiation and application parameters were tested serially. To determine the temperature threshold for endothelial damage, corneal buttons were analyzed separately in a waterbath experiment. The endothelial damage was assessed after trypan blue and alizarin red supravital staining under light microscopy.

RESULTS

The thresholds for the 50% probability of thermal damage (ED50) were determined at corneal temperatures of 65 degrees C for a 10-second water-bath immersion, and 59 degrees C for 60 seconds. Coagulations that reached the deeper stromal layers revealed severe endothelial cellular alterations and areas of exposed Descemet's membrane. The thermally induced changes were dependent on laser power and the absorption coefficient (wavelength). Mean diameter of total endothelial cell damage was 245 +/- 154 microm (range, 0 to 594 microm) for an absorption coefficient of 1.1 mm(-1). The maximal lateral extent of endothelial cell damage induced by the laser exposure was 594 microm in diameter. Increasing the absorption coefficient decreased the penetration depth of the laser irradiation, creating a greater temperature rise within the corneal stroma and significantly less endothelial damage (P < .01), when the same laser power was applied. The calculated total area of damage for the paracentral human corneal endothelium ranged from 1.8% to 13.6%.

CONCLUSION

Data obtained in this in vitro study were transferred to an endothelial cell damage nomogram, demonstrating that appropriate parameter improvements can minimize the adverse effects to the corneal endothelium. However, model adjustment to the human cornea indicates the potential for endothelial cell damage after diode laser thermal keratoplasty, and should be considered when performing this elective procedure.

A method for separation and staining of flat mounts of human corneal endothelium

A technique is described in which sheets of corneal endothelium are removed from human donor corneo-scleral discs. Celloidin solution was applied to the endothelial surface, allowed to dry, peeled off with the attached endothelial cell layer and mounted on a glass slide. Following removal of the celloidin with acetone, this endothelial cell flat mount was then stained with H&E and monoclonal antibodies to cell adhesion molecules. A pilot study of endothelial cell adhesion molecule expression in flat mount preparations of 14 corneas showed constitutive neural cell adhesion molecule (NCAM) expression, but a lower degree of focal expression of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VACM)-1, P/E-selectin and HLA-DR.

Modulation of HLA-DR and CD1a expression on human cornea with low-dose UVB irradiation

PURPOSE

To evaluate the effects of low-dose UVB irradiation of HLA and CD1a expression and the toxic effects of UVB on human corneas.

METHODS

24 pairs of human corneas from 24 donors were studied. One cornea from each pair was randomly irradiated with UVB (100 mJ/cm2) after enucleation. All corneas were then organ-cultured for 2, 7, 14 or 21 days. Endothelium was studied after enucleation and organ culture. Following preservation, corneas were evaluated by means of light microscopy, morphometry and TEM. HLA and CD1a staining was performed using an immuno-alkaline-phosphatase technique.

RESULTS

Endothelial cell loss during organ culture averaged 9.1% in the UVB group and 9.2% in the control group (NS). The number of rosette and reformation figures (p = 0.004) and the coefficient of variation (p = 0.014) were higher in the control group. Epithelial sloughing was more accentuated in the UVB group. We observed the same moderate ultrastructural injuries in both groups. In the epithelium, the average number of HLA-DR+ cells per field was 0.12 in the UVB group and 0.42 in the control group (p = 0.035). In the stroma, these figures were respectively 1.04 and 1.34 (p = 0.026). In the epithelium, the average number of CD1a + cells was respectively 0. 025 and 0.078 (p = 0.019). In the preservation mediums, the average percentage of CD1a + cells was 0.07% in the UVB group and 0.27% in the control group (p = 0.014).

CONCLUSIONS

Low-dose UVB (100 mJ/cm2) decreases HLA-DR and CD1a expression of organ-cultured human corneas and induces moderate corneal injuries. Low-dose UVB might be useful for preventing allograft rejection.

The influence of the cutting procedure on the loss of corneal endothelial cells of the recipient eye in mechanically guided trephination

BACKGROUND

Excessive damage to the endothelial monolayer during corneal trephination may contribute to transplant failure. For this reason, we performed several trephining experiments to determine the influence of various cutting conditions (sharpness, rotation rate, and cutting power) on the endothelial damage in the recipient bed.

METHODS

A mechanically guided motor trephine (Mikro-Keratron) was used for cutting experiments in fresh, enucleated porcine eyes. Eight different, reproducible combinations of cutting conditions were applied, and ten epithelial, full-thickness trephinations were performed for each combination. The endothelial defect was measured with a light microscope (60 x). In addition, the bend radii of the porcine cornea were measured.

RESULTS

The mechanically guided Mikro-Keratron used with a sharp blade, high rotation rate (840 rev/min), and moderate cutting power (49 mN) caused a 31-micron-wide band of damaged endothelium in the recipient bed. Decrease of the rotation rate to 30 rev/min resulted in an increase of the endothelial defect to 168%. A cutting power of 392 mN combined with a rotation rate of 840 rev/min increased the defect to 126%. The system allowed full-thickness 360 degrees trephination. The corneal bend radii in porcine eyes measured 8.28 mm horizontally and 8.20 mm vertically.

CONCLUSION

Our preliminary results indicate that the mechanically guided motor trephine, used under optimal conditions, is a suitable cutting device and may improve the outcome of penetrating keratoplasty; however, further investigation of this new approach is necessary.

Corneal alkali wound healing in the monkey

Healing of a corneal alkali wound was followed in the monkey eye (Macaca fascicularis) for 4 months. A corneal alkali wound was inflicted in one eye in each of 30 monkeys under general anesthesia. A round filter paper, 5.5 mm in diameter, soaked in 1 N NaOH was put centrally on the cornea for 60 seconds. The alkali wounded all layers in the cornea underlying the filter paper, including the endothelium. Epithelial and endothelial healing was assessed morphometrically from photographs and micrographs, respectively. Stromal healing was documented using quantitative microradiography. During the observation period the wounds regained complete transparency. The epithelium showed few complications after primary healing during the first three days. The stroma regained normal thickness and dry mass content within one week. The endothelium resurfaced within one week and then remained intact. The role of the endothelial healing behaviour for the wound healing process is emphasized.

Heparin surface modified intraocular lenses implanted in the monkey eye

The biocompatibility of heparin surface modified poly(methyl methacrylate) intraocular lenses (IOLs) was evaluated in two experiments following implantation in the anterior and posterior eye chambers of adult cynomolgus monkeys. Throughout the study, large inflammatory cells and prominent pigment deposits were seen on the unmodified lenses, whereas the heparin surface modified IOLs remained almost free of precipitates. Similarly, fewer posterior synechias were observed in eyes implanted with surface modified IOLs in the posterior chamber than in eyes implanted with control lenses. Histopathological examination of enucleated eyes confirmed the clinical findings. These experiments strongly support the idea that surface modification with heparin is a useful way to reduce clinical complications following cataract surgery with IOL implantation.

Corneal preservation

Significant advances in corneal preservation have been made over the past decade. The introduction of chondroitin sulfate-containing media for use at 4 degrees C allows storage of corneas for up to ten days prior to transplantation. Organ culture techniques have also been improved with the addition of chondroitin sulfate. There has been an increase in our understanding of preservation using McCarey-Kaufman medium. Studies have been published that compare these methods and help the clinician decide which method to use based on objective data. Also, our understanding of existing methods of evaluating endothelial viability has increased and new methods have been developed. Finally, the acquired immunodeficiency syndrome is having an increasing effect on eye-banking and the supply of donor corneas.

Endothelial healing in rabbit corneal alkali wounds

The healing of rabbit corneal endothelium was studied following a standardized corneal alkali burn. The excised corneas were stained and examined, flat mount, endothelial side up, in the light microscope. Morphometric determinations were performed during the healing process by flat mount technique, and endothelial cell morphology was studied by both histological and flat mount techniques. The decrease of the endothelial wound diameter was linear, in the order of 18 micron/h, during the first 5 days. By one week the wound was almost completely covered by endothelial cells. Subsequently, the endothelium broke down in the central wound area during the second week. Endothelial healing resumed after the secondary break down although at a slow pace. The healing was often interfered with by invading fibroblast-like cells. The endothelial wound was not completely covered by endothelial cells even 6 months after trauma. The interrelation of the damage in different layers of the cornea was discussed.

Experimental endothelial lesions by means of an ultrasound phacoemulsificator

The current study deals with experimental use of an ultrasound generator for phacoemulsification and its effect on bovine corneal endothelium. The extent of the endothelial defect was defined by staining cell borders and nuclei. Histological examination showed that endothelial cells on the edge of a defect had no nuclei and were partially detached from the Descemet's membrane in some cases. Quantitative determinations of endothelial cell defects demonstrated the effects of distance from the generator (1, 2, and 3 mm) as well as duration of exposure. At 2 and 3 mm, addition of sodium hyaluronate (Healon) to the incubation medium was associated with a statistically significant reduction in size of the endothelial defect.

Clinical cryobiology of tissues: preservation of corneas

It is well recognized that the clarity of the cornea is a function of its hydration, and that this hydration is controlled by a "pump-and-leak" mechanism operating across the posterior monolayer of cells called the endothelium. A breakdown of the endothelium through disease or injury causes a marked increase in corneal thickness as the stroma imbibes fluid from the aqueous humor in the anterior chamber of the eye. This thickened, edematous condition of the stroma results in a cloudy cornea with an associated marked decrease in visual acuity. Treatment for this condition is usually by full-thickness corneal transplantation (penetrating keratoplasty), the success of which is dependent upon the donor cornea having an intact and healthy endothelium. It is essential, therefore, that any method of corneal storage for penetrating keratoplasty should protect and preserve the endothelium in a viable state. Current clinical practice relies upon short-term methods of preservation by two principal methods. Moist Chamber Storage is the time-honored corneal preservation method; it consists of keeping enucleated eyes at 0-4 degrees C in a sealed jar containing a pad of cotton gauze soaked in saline to provide a humid environment. The time limit placed upon this method of storage is 24-48 hr after which the viability of the endothelium deteriorates rapidly. Storage in M-K (McCarey-Kaufman) Medium involves excision of the corneoscleral segment from the donor eye and immersing it, endothelial side uppermost, in a medium consisting of tissue culture medium, 5% Dextran 40, and antibiotics. Laboratory and clinical studies indicate that storage in M-K medium at 4 degrees C preserves human endothelial cells for up to 4 days when the eye has been removed from the cadaver in less than 10 hr postmortem. Long-term preservation of corneas by freezing has long been a major goal in eye banking because indefinite storage by cryopreservation offers significant advantages for the quality and the quantity of material for use in keratoplasty, as well as for its distribution. However, procedures that have been developed for the cryopreservation of corneas have not been widely used, and a number of studies have shown that these procedures are inadequate for maintaining the integrity of the corneal endothelium. Not surprisingly, clinicians are now reluctant to accept corneas that have been frozen by these methods, though the clinical need is now greater than ever.(ABSTRACT TRUNCATED AT 400 WORDS)

Ultrastructure of cryopreserved, functioning human corneal endothelium

The endothelium was studied by light- and electronmicroscopy in a cryopreserved cornea transplanted to a woman with herpetic keratitis and removed after 18 months because of wound dehiscence and epithelialization of the anterior chamber. The graft was perfectly transparent and of normal thickness. Light microscopy revealed the existence of a continuous layer of endothelial cells, showing pronounced pleomorphism when examined in flat preparation, with large multinuclear cells between smaller more normal looking mononuclear cells. The heterogeneous cell pattern resembled that observable in vitro after freezing and 24 h of culture. The cells therefore are not considered to be in a steady state. The ultrastructure of the majority of the cells was similar to that of non-cryopreserved endothelium. Cell cohesion took place by tight junctions, the intercellular spaces were of normal width. Ultrastructurally there was, however, a cellular heterogeneity, due to the occurrence of light cells with few organelles, but always with intact cell membranes. These cells probably represent slow death of endothelial cells, demonstrated by falling cell density during the 18 months between grafting and examination. We conclude from this study that cells surviving the freezing can maintain a clinically normal endothelial function for 18 months by forming a continuous quasistatic monolayer of tightly bound living cells.

Post-operative thickness and endothelial cell density in cultivated, cryopreserved human corneal grafts

Seventeen corneas obtained 2-72 h post mortem, from donors aged 17-78 years, were cultivated for 24 h, cryopreserved, thawed, cultivated for another 24 h and grafted. One year post-operatively 12 of the 17 grafts were clear. In 10 of these 12 cases the visual acuity was greater than or equal to 0.33. One primary graft failure occurred, while 4 primarily clear grafts became cloudy due to glaucoma (2), phthisis bulbi (1) and herpetic reinfection (1). One year after the transplantations the central thickness of the clear grafts was 0.51 mm, and the endothelial cell density was 1028 cells/mm2, corresponding to 32% of the cell density before cryopreservation. This endothelial cell loss was not correlated to donor age or to the time between the death of the donor and the primary cultivation.

Dual staining of corneal endothelium with trypan blue and alizarin red S: importance of pH for the dye-lake reaction

Evaluation of corneal endothelial integrity by combined staining with the vital stain trypan blue and the intercellular stain alizarin red S provides a simple, quick technique for visualisation of both damaged and normal cells, thereby permitting the quantification of endothelial cell damage. Adjustment of the pH of the alizarin red S reagent to 4.2 is important for optimum dye-laking at the intercellular borders, and brief fixation with glutaraldehyde maintains the staining effect of both dyes.

Cryopreservation of human cadaver corneas regenerated at 31 degrees C in a modified tissue culture medium

Human corneas were obtained 2-82 h post mortem, cultured for 20-28 h, in a modified tissue culture medium, frozen at a controlled rate, and thawed rapidly. The thawed corneas were subjected to 20-28 h of additional culture. Immediately after thawing, a mean endothelial cell damage of 11% was indicated by trypane blue staining. The mean endothelial cell loss during the subsequent culture was 34%. This cell loss was not related to post mortem time, to donor age, to cell loss during the primary culture, or to endothelial cell density.

Shrinkage in preparatory steps for SEM. A study on rabbit corneal endothelium

Since specular microscopy of the cornea offers the opportunity to observe and measure cells in vivo without any outside interference this method forms an unrivalled basis for estimation of tissue shrinkage during various preparatory methods. Therefore a study was performed with the purpose of evaluating the degree of artifacts in each preparatory step from the living tissue "in vivo" to the final SEM specimen. The study was performed on rabbit corneas, the endothelium serving as measuring target. The in vivo state was recorded by specular microscopy. Unfixed corneas were studied by light microscopy unstained and stained by alizarin red S or silver nitrate. Fixation was performed intracamerally with 1.5% glutaraldehyde (Gla) by a pH, osmolarity, viscosity and intraocular pressure identical with the physiological values of rabbit eyes. Fixation was completed by immersion in 2.5% Gla for 1/2 h. Gla-fixed corneas were evaluated as above before osmification. Dehydration was performed either by graded acetone, by acetone in a gradient-free system, both followed by critical point drying (CPD). At all steps cells were counted using the same reference frame. The number of cells/mm2 was estimated and statistical analysis showed a shrinkage of 22 per cent (area) in unfixed tissue, 26 per cent (area) in normally dehydrated tissue and 37 per cent (area) in gradient free dehydrated tissue processed for SEM.

Human corneal endothelium in organ culture. The influence of temperature and medium of incubation

Forty-four human corneas from patients between 21 and 86 years were incubated in Eagle's minimum essential medium with Earle's salts 10--46 h post mortem. The influence of incubation temperature and composition of the medium on endothelial survival was evaluated. Whole corneas were stained by alizarine red. Recent cell loss was indicated by morphological alterations in the endothelial pattern. After 20--28 h of incubation minimum cell loss was found at 31 degrees C when 8% Dextrane-250 and 20% serum or 8% Dextrane-500 and 10% serum was added to the medium.