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

• Published in: International ophthalmology Vol. 42; no. 1; pp. 133 - 145
• Main Authors: Minami, Mayumi, Chihara, Etsuo
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.01.2022; Springer Nature B.V
• Subjects: Automation; Cell Count; Cell density; Coefficient of variation; Computer programs; Cornea; Density; Endothelial Cells; Endothelium, Corneal; Glaucoma; Glaucoma - diagnosis; Hexagonal cells; Humans; Medicine; Medicine & Public Health; Methods; Microscopy; Ophthalmology; Original Paper; Software; Glaucoma; Corneal endothelial cell density; Automated method; Non-contact specular microscopy; Center method
• ISSN: 0165-5701; 1573-2630; 1573-2630
• DOI: 10.1007/s10792-021-02008-4

Purpose To 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. Methods We 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/mm 2 intervals) and evaluated the ECD, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX). Results There 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/mm 2 . None of the 44 subjects with an ECD-Ce of < 1000 cells/mm 2 recorded an ECD-Au < 1000 cells/mm 2 . 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). Conclusion The automated method of the CellCheck software overestimates ECD in eyes with lower ECD values and may overlook risk of corneal decompensation.