Comparison of the Center and Flex-Center Methods of Corneal Endothelial Cell Analysis in the Presence of Guttae

Huang, Jianyan; Li, Xuan; Tepelus, Tudor; Nazikyan, Tigran; Chopra, Vikás; Sadda, Srinivas R; Lee, Olivia L

doi:10.1097/ico.0000000000001334

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Huang and others reported that in corneas with guttae, the center method yields an accurate ECD value when there are ≥ 30 contiguous countable cells in an image. If the number of countable cells is less than 30, the flex-center method may be more suitable [ 15 ], and a minimum of 30 cells may be appropriate to obtain an accurate ECD value using the center method.…”

Section: Discussionmentioning

confidence: 99%

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

Minami

Chihara²

2021

Int Ophthalmol

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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/mm2 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/mm2. None of the 44 subjects with an ECD-Ce of < 1000 cells/mm2 recorded an ECD-Au < 1000 cells/mm2. 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.

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Section: Discussionmentioning

confidence: 99%

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

Minami

Chihara²

2021

Int Ophthalmol

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“…In order to achieve most reliable ECD values (single best is better than averaging), the graders were to grade on the best quality image of their own choice out of the three. ECD and CV values were evaluated using the Konan center method25–27 in CellChek software. Any eye with very low ECD signifying pathologic endotheliopathy (ECD ≤ 800 cells/mm 2 ) were excluded from analysis.…”

Section: Methodsmentioning

confidence: 99%

Representation of Central Endothelial Cell Density by Analysis of Single Best Specular Microscopy Image Regardless of Cell Size Variance

Shi

Huang

Baghdasaryan

et al. 2019

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study is to evaluate whether a single best image can represent central endothelial cell density (ECD) in corneas of differing cell size coefficient of variance (CV). Methods Four hundred one healthy eyes but with variant CV values were enrolled. For each eye, three nonoverlapping central cornea endothelium images were obtained with Konan NSP-9900 specular microscope. ECD and CV were evaluated by two independent graders using the well-established Center method. Only corneas with high image quality rating (IQR) and ECD >800 cell/mm 2 by both graders were included in the study. The study sample was stratified into five CV levels (CV ≤ 35; ≥36; ≥38; ≥40; and ≥45). In each CV level, the ECD agreement, ECD variance, and the correlation between the ECD variation and CV values were analyzed. In addition, the ECD intragrader reproducibility and interframe differences were also analyzed for all levels except CV ≤ 35. Results The study sample includes a total of 278 eyes. High ECD agreement for the two independent graders (intraclass correlation coefficient [ICC] > 0.99), high ECD intragrader reproducibility (ICC > 0.95), low ECD variance (2.0% ± 1.6%, overall), no correlation between the ECD variation and the CV value ( P > 0.05), and no significant ECD difference among frames ( P > 0.05) was found in any studied CV levels. Conclusions CV does not appear to be associated with ECD variance in the central cornea. Translational Relevance This finding highlights that in healthy corneas but with high CV values, ECD can be reliably analyzed using one single image of best quality.

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“…Our mean absolute difference between the two devices (93.3 cells/mm 2 , 3.45%) is significantly lower than the 5% cutoff defined by the Cornea Donor Study Group as an interobserver variance standard for good-quality analysis while using the same noncontact SM, the Konan machine. Huang et al 16,18 compared the fully automatic mode with the semiautomatic mode of the Konan SP-9900 device using the center and flex-center methods in normal and glaucomatous eyes. They found that automated analysis tended to overestimate ECD in both healthy control and diseased eyes, compared with semiautomated (manual) analysis.…”

Section: Discussionmentioning

confidence: 99%

Agreement of Corneal Endothelial Cell Analysis Between Konan-Noncon Robo SP-6000 and Tomey EM-3000 Specular Microscopes in Healthy Subjects

Jbara

Achiron

Antman

et al. 2020

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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To compare corneal endothelium parameters taken by two common noncontact specular microscopes in healthy subjects. Methods: Healthy participants visiting the outpatient eye clinic at the Rabin Medical Center, Petah Tikva, Israel, were recruited prospectively. All participants underwent three consecutive corneal endothelial cell photographs with both the Konan-Noncon Robo SP-6000 and the Tomey EM-3000 specular microscopes. Endothelial cell density (ECD) was evaluated using the manual center technique in both machines. Bland-Altman graphs were used to assess the agreement between the devices, and intraclass correlation coefficient (ICC) served to assess intraobserver variability for each device. Results: Recruited were 49 healthy subjects with a mean age of 48.9615.6 years, 49 right eyes were included. The mean ECD was comparable between the Tomey EM-3000 and the Konan-Noncon Robo SP-6000 (2,713.26242.4 vs. 2,700.86300.5 cells/mm 2 , respectively, P¼0.47) with a mean difference of 12.4 cells/mm 2 (0.67%), a mean ECD absolute difference of 93.3 cells/mm 2 , and low 95% limits of agreement of 2222.0 to +246.9 cells/mm 2 . A folded empirical distribution function curve showed that all differences fell within 525.4 cells/mm 2 , centered around a median of 13.3 cells/mm 2 . Intraclass correlation coefficient was high for both the Konan-Noncon Robo SP-6000 (0.93, 95% confidence interval [CI]: 0.89-0.95) and the Tomey EM-3000 (0.88, 95% CI: 0.82-0.93). Conclusions:The difference in endothelial cell measurements between the Konan SP-6000 and the Tomey EM-3000 specular microscopes through the center and the L-count analyzing techniques, respectively, is clinically small and not statistically significant. Nevertheless, caution should be taken when used interchangeably because ECD difference between the two machines can be as high as 525.4 cells/mm 2 .

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Comparison of the Center and Flex-Center Methods of Corneal Endothelial Cell Analysis in the Presence of Guttae

Cited by 7 publications

References 23 publications

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

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

Representation of Central Endothelial Cell Density by Analysis of Single Best Specular Microscopy Image Regardless of Cell Size Variance

Agreement of Corneal Endothelial Cell Analysis Between Konan-Noncon Robo SP-6000 and Tomey EM-3000 Specular Microscopes in Healthy Subjects

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