Regional specular microscopy of endothelial cell loss after intracapsular cataract extraction: A preliminary report

Abstract

In a group of 10 patients (12 eyes) undergoing intracapsular cataract extraction, corneal endothelial cell loss was serially investigated by means of regional specular microscopy. Prevoperatively there were no significant regional differences in the endothelial cell density. Two weeks after surgery, the superior endothelium alone showed a significant cell loss (15.6%). Whereas, a definite endothelial cell loss occurred in each region of the cornea one month after surgery. The cell loss was greater in the superior (22.8%) and lower in the inferior (4.7%), respectively, when compared to that seen in the central cornea (9.6%). In each region, cell loss continued 3 months postsoperatively, but no significant cell loss occurred thereafter. These results suggest that the entire endothelial cell population may participate in the healing of the damage associated with intracapsular cataract extraction and that regional specular microscopy can be of help for detailed evaluation of such a damage.

Embracing an Epoch-Making Change as We Move from Japanese to English: the 13th Annual Meeting of the KCC, Nov 30-Dec 1, 2007

“…The number of cells counted to obtain a maximum accuracy per image has been suggested by Laing et al 21 to be at least 30 cells per image, Doughty 50 suggests at least 75 cells per image and Inaba et al 32 prefers using 100 cell per image. Binder et al 22 expanded the guideline by suggesting as many cells in the image frame as possible, with three images per patient from the center and paracentral regions.…”

“…The data points (diamonds) are from a Japanese patient group (linear line, Y=4109-124X) and the data (triangles) are from an Caucasian American patient group (linear line, Y=3254-121X) 18 . Mean endothelial cell density values for ICCE patients (Inable eta 1985 32 ) are plotted in Graph A to demonstrate regional endothelial cell changes after superior incision ICCE. In Graph B, ECCE patient data from Schultz et al 33 shows regional endothelial cell changes after ECCE with IOL implantation with 1% sodium hyaluronate (Healon).…”

Corneal Endothelial Changes in Correlation with Corneal Thickness after Phacoemulsification among Diabetic Patients

“…A cornea with a cell density of 1500 cell/mm 2 had a maximum number of 65 cells. When the human corneal endothelium is damaged [16], the healing is a process of cellular enlargement and spreading to create a contiguous layer of cells on the inner surface of the cornea. The degree of endothelial cell loss from, for example, disease, trauma, or chemical toxicity can be documented with specular microscopy as an increase in individual cell surface area and a decrease in the endothelial cell density for the cornea.…”

How many cells are supposed to be counted on the specular microscopy exam?

“…Doughty et al suggested that at least 75 cells should be counted per image (4) . Inaba et al preferred to include at least 100 cells per image (5) . Binder et al suggested the inclusion of all cells of at least three images of the central and paracentral regions (6) .…”

“…The use of 10 to 20 cells, as recommended by the equipment manual instructions, is reckless, as this manual must have been written over two decades ago. From that time until now, the understanding of the number of endothelial cells necessary for an exam has changed (4)(5)(6)(8)(9) . The Cells Analyzer software calculates the statistical significance of endothelial samples obtained by the specular microscopy (9) , with all endothelial data described on figure 1 of the article (endothelial density 2,026 cells/mm², area 493.5 µm² and coefficient of variation of 30) which 12 cells are counted; the calculated sample error is 17% when it should be less than 5% for a confidence degree of 95%, i.e., sample error 340% superior to the accepted by the medical science (5%).…”