Eye & Contact Lens

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Eye & Contact Lens: Science & Clinical Practice:
doi: 10.1097/ICL.0b013e318203dc19

Endothelial Image Quality After Descemet Stripping With Endothelial Keratoplasty: A Comparison of Three Microscopy Techniques

Raecker, Matthew E. M.D.; McLaren, Jay W. Ph.D.; Kittleson, Katrina M. B.S.; Patel, Sanjay V. M.D.

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Purpose: To determine corneal endothelial image quality after descemet stripping with endothelial keratoplasty (DSEK) as recorded by three different microscopy techniques: noncontact specular microscopy, noncontact confocal microscopy, and contact confocal microscopy.

Methods: The corneal endothelium of 52 eyes after DSEK and 20 normal eyes was photographed by the three microscopy techniques during a single encounter. Image quality was graded by two masked observers according to the proportion of countable contiguous cells visible in the image; disagreements in grading were adjudicated by a third observer. Endothelial cell density was compared among the three techniques.

Results: After DSEK, image quality was better with contact confocal microscopy than with noncontact confocal microscopy (P = 0.01) and better with noncontact confocal microscopy than with noncontact specular microscopy (P < 0.001). With noncontact specular microscopy, 42% of images after DSEK were uncountable. In normal corneas, all images were countable, and although image quality was better with contact confocal microscopy than with noncontact confocal (P = 0.03) and noncontact specular (P < 0.001) microscopy, the difference was not clinically important. For countable images, the mean differences in endothelial cell density between microscopy methods were close to zero after DSEK and in normal corneas.

Conclusions: Confocal optics enable better image quality of the corneal endothelium in corneas with high backscatter, such as those after DSEK. When images were countable, there was a good agreement for endothelial cell density measured by the three microscopy techniques.

© 2011 Lippincott Williams & Wilkins, Inc.


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