Comparison of Corneal Endothelial Cell Images From a Noncontact Specular Microscope and a Scanning Confocal Microscope

Kitzmann, Anna S.; Winter, E. J.; Nau, Cherie B; McLaren, Jay W.; Hodge, David O.; Bourne, William M.

doi:10.1097/01.ico.0000159737.68048.97

Cited by 63 publications

(63 citation statements)

References 20 publications

(20 reference statements)

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“…In the current study, the potential effect of magnification on ECD was accounted for by the NAVIS software, which contains an internal calibration for magnification. 14 CCT measurement in this study (529 mm) was slightly less than that reported by Sanchis-Gimeno et al 30 (554 ± 16 mm), who studied the corneal thickness of 1000 young (range 20-30 years) emmetropic subjects using a similar Orbscan II slit-scanning corneal topography system. Comparison of CCT with other published reports is limited due to differences in measurement technique.…”

Section: Discussioncontrasting

confidence: 64%

“…5,9,16,17,26,27 With regards to the reliability and repeatability of the NAVIS endothelial analysis system, automated endothelial analysis often fails to correctly identify endothelial cell borders. 14,28 However, Kitzman et al 14 have demonstrated that after manual correction of cell borders detected by the NAVIS automated software, the endothelial density, coefficient of variation of cell area, and percentage of hexagonal cells were not different from those determined by the Corners method. They therefore concluded that if the ConfoScan and its proprietary programme are used to determine cell density, investigators must manually correct cell boundaries on the images.…”

Section: Discussionmentioning

confidence: 99%

“…For manual correction, the polygons were superimposed over the image of the endothelial cells, and the user was allowed to add, delete, and move the polygon's apices based on visual inspection. 14 …”

Section: Assessmentmentioning

confidence: 99%

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Identifying relationships between tomography-derived corneal thickness, curvature, and diameter and in vivo confocal microscopic assessment of the endothelium in healthy corneas of young adults

Patel

McGhee

2008

Eye

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Purpose Despite the importance of a healthy endothelial layer in anterior segment surgery, the possible influence of corneal parameters on endothelial cell density (ECD) has largely been ignored in the young adult eye. This study investigated the possible associations between corneal tomographic parameters and ECD values in young adults. Methods Subjects aged 21-30 years, with normal corneas were recruited. Mean ECD, mean cell area (MCA), coefficient of variation for cell area (COVA), and proportion of hexagonal cells were derived by in vivo confocal microscopy. The Orbscan II system was used to measure corneal parameters including: thickness, horizontal corneal diameter, corneal curvature, anterior and posterior elevation, and eccentricity. Results Sixty-two subjects (42 female, 20 male) were included (mean age 25±3 years). Overall mean ECD was 3169±309 cells/mm 2 with no differences between genders. Mean percentage of hexagonality was 53 ± 5%, male subjects (55%) had a higher percentage of hexagonal cells than female subjects (51%) (P ¼ 0.02). Central corneal thickness (CCT) was 529±43 lm. Central ECD was significantly correlated with CCT (Pearson's r ¼ 0.26, P ¼ 0.04). However, horizontal corneal diameter (r ¼ 0.19, P ¼ 0.14), anterior corneal curvature (r ¼ À0.07, P ¼ 0.6), and posterior corneal curvature (r ¼ À0.07, P ¼ 0.6) were not correlated with ECD or percentage of hexagonality. There was no statistically significant association between anterior chamber depth (3.6±0.3 mm) and ECD (r ¼ 0.15, P ¼ 0.3). Conclusion Corneal thickness is related to ECD in normal young adult eye, with lower ECD values identified in thinner corneas; however, corneal diameter and corneal curvature do not have a significant correlation with ECD.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Identifying relationships between tomography-derived corneal thickness, curvature, and diameter and in vivo confocal microscopic assessment of the endothelium in healthy corneas of young adults

Patel

McGhee

2008

Eye

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“…25,26 Klais et al 27 compared corneal endothelial cell counts in 42 normal eyes obtained by confocal and specular microscopy and found measurements to be comparable with both methods. Similarly, Kitzmann et al 28 showed that endothelial cell density measured from the images recorded by confocal and specular microscopy were not significantly different from each other when the same programme was used for the measurement.…”

Section: Discussionmentioning

confidence: 99%

Coupling of HRT II and AS-OCT to evaluate corneal endothelial cell loss and in vivo visualization of the Ahmed glaucoma valve implant

Mendrinos

Dosso

Sommerhalder

et al. 2008

Eye

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“…[22][23][24][25][26] Such agreement for ECD values was, however, obtained on relatively normal appearing endothelia with high ECD values and did require manual correction of erroneous cell boundaries created by the automated method. 24,25 The main purpose of this study was to evaluate the agreement of three endothelial analysis methods used on endothelial images obtained with the Confoscan 4 scanning-slit confocal microscope after corneal transplantation. The reliability of ECD estimates for relatively normal and for very abnormal-appearing endothelia was also evaluated.…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Jonuscheit

Doughty

Ramaesh

2011

Eye

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Purpose The purpose of this study was to assess the endothelium of corneal grafts by in vivo confocal microscopy (IVCM), and to evaluate an automated endothelial software system in comparison with a manual cell count and planimetry. Patients and methods Overall, 40 corneal grafts (20 deep anterior lamellar keratoplasties (DALKs) and 20 penetrating keratoplasties (PKs)) were assessed by scanning-slit IVCM. The endothelial cell density (ECD) was estimated with the automated and the manual cell count method of the instrument's Nidek Advanced Vision Information System (NAVIS) software. The results were compared with planimetry as the reference method, and the agreement was assessed. Results The mean ( ± SD) automated ECD was 2278 ± 524 cells/mm 2 (range 1167-3192 cells/mm 2 ), whereas the manual cell count method gave significantly lower ECDs with a mean of 1213±677 cells/mm 2 (range 218-2440 cells/mm 2 ; Po0.001). The manual cell counts were also significantly lower than those by planimetry, with a mean ECD of 1617 ± 813 cells/mm 2 (range 336-2941, Po0.001). Bland-Altman analyses indicated that the limits of agreement (LoA) between the automated and the planimetry method were À671 and þ 1992 cells/mm 2 , whereas they were À1000 and þ 202 cells/mm 2 when comparing the manual cell counts with planimetry. Conclusion Following keratoplasty, the NAVIS automated method is likely to overestimate endothelial cell counts due to oversegmenting of the cell domains. Automated ECDs are substantially higher than those by the manual counting method or planimetry. The differences are considerably larger post-keratoplasty than for normal corneas, and the methods should not be used interchangeably.

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Comparison of Corneal Endothelial Cell Images From a Noncontact Specular Microscope and a Scanning Confocal Microscope

Abstract: The ConfoScan 3 can be used interchangeably with the Robo when the Corners method is used to assess ECD and the magnification of both microscopes is calibrated with an external scale. If the proprietary software provided with the ConfoScan 3 is used, it should be manually corrected.

Cited by 63 publications

References 20 publications

Identifying relationships between tomography-derived corneal thickness, curvature, and diameter and in vivo confocal microscopic assessment of the endothelium in healthy corneas of young adults

Identifying relationships between tomography-derived corneal thickness, curvature, and diameter and in vivo confocal microscopic assessment of the endothelium in healthy corneas of young adults

Coupling of HRT II and AS-OCT to evaluate corneal endothelial cell loss and in vivo visualization of the Ahmed glaucoma valve implant

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

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