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Influence of Cataract Surgery on Corneal Endothelial Cell Density Estimation

Wirbelauer, Christopher MD; Wollensak, Gregor MD; Pham, Duy Thoai MD

Clinical Sciences

Purpose: To assess the effect of cataract surgery on semiautomated human corneal endothelial cell density (ECD) estimation using noncontact specular microscopy.

Methods: In this prospective clinical study, 62 consecutive patients undergoing cataract surgery were studied. To evaluate possible variations of accuracy and agreement under clinical circumstances, the corneal ECD was determined before and after cataract surgery. The parameter ECD (cells/mm2) in the central and paracentral cornea was consecutively determined with 2 algorithms available in a noncontact specular microscope [fixed-frame method (FFM) and automatic center method (ACM)]. The postoperative evaluation was performed at 1 day, after 4 weeks, and after 6 months. The accuracy, the relative error, and the 95% limits of agreement (LoA) were determined for both counting methods.

Results: The overall group-averaged accuracy was −19.4 cells/mm2 (0.86%) centrally and −17.3 cells/mm2 (0.76%) paracentrally. The LoA (95% CI) were within 234 cells/mm2 (10.4%) and 250 cells/mm2 (10.9%), respectively. After cataract surgery, a slight decrease in accuracy was noted in the central (2.09%) and paracentral areas (1.76%). The relative error increased from 3.66% to 6.02% centrally and from 4.96% to 6.55% paracentrally. The LoA (95% CI) increased from ±194 cells/mm2 to ±304 cells/mm2 centrally and from ±275 cells/mm2 to ±322 cells/mm2 paracentrally. In the later postoperative period, endothelial stabilization improved the accuracy and agreement in ECD estimation.

Conclusions: The estimation of ECD after cataract surgery employing current algorithms was achieved with a clinically acceptable level of accuracy and agreement. However, the analysis of images in the early postoperative period as well as paracentral corneal areas revealed larger variabilities. This revealed that the FFM and ACM counting methods cannot be used interchangeably under all circumstances. The ACM seemed preferable when only low-quality images were available and permitted determination of additional qualitative endothelial cell parameters.

From the Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin, Germany.

Received for publication September 19, 2003;

The authors have no commercial, proprietary, or financial interest in any research or devices described in the presented study.

Reprints: Christopher Wirbelauer, MD, Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Rudower Str. 48, D-12353 Berlin, Germany (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.