Comparison of manual and automated endothelial cell density analysis in normal eyes and DSEK eyes.
OBJECTIVE
To compare automated endothelial cell density analysis with manual cell detection methods with 3 imaging devices.


METHODS
In this prospective study, the corneal endothelium of 54 Descemet stripping endothelial keratoplasty (DSEK) eyes and 28 normal eyes was analyzed with a Nidek Confoscan 4 confocal microscope using a 20× noncontact lens and with Tomey EM-3000 and Konan Noncon Robo SP-8800 specular microscopes. Testing order was randomized. The Confoscan and Robo images were presented in a blinded fashion to an experienced technician for manual cell identification and analysis using the manufacturer's software. A different operator determined endothelial cell density using fully automated software associated with each imaging device. Agreement between methods was assessed by repeated-measures analysis of variance and post hoc Tukey analysis.


RESULTS
Manual cell identification on Robo and Confoscan 4 images produced comparable cell density measurements in normal eyes (P = 0.73) and DSEK eyes (P = 0.11). The Confoscan automated cell detection software differed significantly from manual cell detection in both normal and DSEK eyes (P = 0.0003 and P < 0.0001, respectively). The Robo automated cell detection software produced results comparable with manual cell detection in normal eyes (P = 0.082) but significantly overestimated cell density in DSEK eyes (P < 0.0001). The EM-3000 automated cell detection produced results comparable with manual cell detection in normal eyes (P = 0.067) and DSEK eyes (P = 0.49).


CONCLUSIONS
Only 1 of 3 automated cell detection programs produced cell density readings comparable with those obtained with manual cell identification; the other 2 automated programs significantly overstated endothelial cell density in DSEK eyes.
Cornea Research Foundation of America, Indianapolis, IN 46260, USA. marianneprice@cornea.org
Marianne O
MO
Price
Kelly M
KM
Fairchild
Francis W
FW
Price
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count / Q000295:instrumentation; D057111:Descemet Stripping Endothelial Keratoplasty; D003952:Diagnostic Imaging / Q000295:instrumentation*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D004728:Endothelium, Corneal / Q000166:cytology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D055815:Young Adult