title: Urgent need for normalization of corneal graft quality controls in French eye banks.
abstract: BACKGROUND
  Assessment of corneal tissue quality before graft is mainly based upon the determination of endothelial cell density (ECD) by eye banks. These cells are responsible for corneal transparency, and ECD correlates with graft survival. In France and often elsewhere in Europe, ECD is measured using a "naked-eye" procedure under a light microscope. To measure objectively the reliability of ECD determination in France, we developed four test corneas with a known ECD.
  
  
  METHODS
  The test corneas consisted of 1 mm2 of human corneal endothelium with stained cell borders. The 64 technicians of the 21 French eye banks counted according to the protocol applied in their respective centers.
  
  
  RESULTS
  More than half of the 256 counts (152, 59%) deviated by more than 10% from actual ECD. Of the counts, 85 (33%) were over-estimated, and 67 (26%) were under-estimated. Deviation ranged between 42% under-estimation and 82% over-estimation. Eight banks (38%) constantly over-estimated, and nine (43%) under-estimated ECD. Half of the inter-technician gaps within an eye bank were more than 10%, with a maximum of 51%.
  
  
  CONCLUSIONS
  This audit highlights the unacceptable lack of reliability of manual ECD assessment in French eye banks. This surely indicates the delivery of poor quality corneas for graft in certain centers and wastage in others. We urgently advocate normalization of French counting methods. This may require upgrading to a computer-aided method.
authors.affiliation: Department of Ophthalmology, University Hospital, Saint-Etienne, France. gilles.thuret@univ-st-etienne.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
authors.forename: Chloé
authors.initials: C
authors.lastname: Manissolle
authors.forename: Sophie
authors.initials: S
authors.lastname: Acquart
authors.forename: Olivier
authors.initials: O
authors.lastname: Garraud
authors.forename: Lydia
authors.initials: L
authors.lastname: Campos-Guyotat
authors.forename: Jean
authors.initials: J
authors.lastname: Maugery
authors.forename: Philippe
authors.initials: P
authors.lastname: Gain
mesh_terms: D002452:Cell Count; D016039:Corneal Transplantation / Q000592:standards*; D042783:Endothelial Cells / Q000166:cytology; D004728:Endothelium, Corneal / Q000166:cytology; D005125:Eye Banks; D006801:Humans; D011786:Quality Control