Overestimation of corneal endothelial cell density by automated method in glaucomatous eyes with impaired corneal endothelial cells

Mayumi Minami,Etsuo Chihara

doi:10.1007/s10792-021-02008-4

Mayumi Minami, Etsuo Chihara

Open Access

https://doi.org/10.1007/s10792-021-02008-4

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Journal: International Ophthalmology	Publication Date: Sep 5, 2021
Citations: 4	License type: open-access

Affiliation: Minamiaoyama Eye Clinic

Abstract

PurposeTo determine between-method differences in corneal endothelial cell parameters using center and automated methods of non-contact specular microscopy (CellCheck software of Konan, Inc.) in glaucomatous eyes.MethodsWe analyzed the central corneal endothelial cell density (ECD) of 245 glaucomatous eyes using center (ECD-Ce) and automated methods (ECD-Au). Based on the ECD-Ce, we allocated subjects to Groups 1 to 10 (at 250 cells/mm2 intervals) and evaluated the ECD, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX).ResultsThere was a close correlation (r = 0.91) between the ECD values measured using both methods. However, ECD-Au were significantly higher than those measured by the center method when ECD-Ce was less than 2500 (in Groups 1 to 8; P < 0.001 to P = 0.006). The regression equation of (ECD-Au—ECD-Ce) = 1028–0.397*ECD-Ce shows greater deviation in eyes with lower ECD, and this difference became 0 when ECD -Ce was 2593 cells/mm2. None of the 44 subjects with an ECD-Ce of < 1000 cells/mm2 recorded an ECD-Au < 1000 cells/mm2. Compared with the center method, the automated method had higher and lower median CV and HEX values, respectively (P < 0.001). The between-method differences in both CV and HEX were negatively correlated with ECD-Ce (r = −0.49, P < 0.001 and r = −0.25, P < 0.001, respectively).ConclusionThe automated method of the CellCheck software overestimates ECD in eyes with lower ECD values and may overlook risk of corneal decompensation.

Highlights

Corneal endothelial cells have ion transport systems that counteract water imbibition by the corneal stroma, and maintain corneal clarity
To determine the critical Endothelial cell density (ECD) level, we provided a scatterplot to study the correlation between the difference between ECD-Au was significantly higher in Groups 1–8 (ECD-Ce) and ECD data utilizing the automated method (ECD-Au), and we allocated subjects into groups based on the ECD-Ce (250 cells/mm2 intervals) and analyzed between-method differences
ICC intraclass correlation coefficients, 95% CI 95% confidence interval, ECD endothelial cell density, CV coefficient of variation in cell area, HEX percentage of hexagonal cells for HEX (ICC (1,5) = 0.514) and CV (ICC (1,5) = 0.412) by the center method showed fair reproducibility (Table 1)

Summary

Introduction

Corneal endothelial cells have ion transport systems that counteract water imbibition by the corneal stroma, and maintain corneal clarity. Severe endothelial cell loss can cause bullous keratopathy. There are multiple glaucoma treatment methods; among them, trabeculectomy and tube shunt surgery may affect the corneal endothelium [1]. It is important to accurately assess corneal endothelial cell parameters to evaluate the risk of corneal decompensation and choose appropriate glaucoma treatment methods. Endothelial cell density (ECD) is an important parameter for assessing endothelial function and health. Polymegathism, determined by the coefficient of variation in cell area (CV), and pleomorphism, represented by the percentage of hexagonal cells (HEX), are other important parameters that indicate stress to the endothelium [2]

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