This prospective study intended to quantify and classify morphological changes of the corneal endothelium in pseudoexfoliation syndrome (PSX) after having tested reproducibility and validity of a new automated technique for analysing corneal endothelium.
Patients and methods: We used a contact specular microscope combined with a video camera (Tomey EM-1000) and a computer (IBM compatible PC, 486DX33) with suitable software (Tomey EM-1100, version 0.94). Video images of corneal endothelium (area: 0.312 mm2) are passed directly into the computer input by means of a frame grabber and are automatically processed. Missing or falsely recognized cell borders are corrected using the mouse. We examined 85 eyes with PSX and 33 healthy control eyes. At first, retest-stability and validity of the cell density measurements were assessed in the PSX-eyes. A qualitative analysis of the corneal endothelium followed.
Results: The cell density measurements showed a high retest-stability (reliability coefficient r = 0.974). The values of the automated method (2040 +/- 285 cells/mm2) and those of manual cell counting (2041 +/- 275 cells/mm2) did not differ significantly (p = 0.441). The mean difference was 3.1 +/- 2.4%. Comparing the 85 PSX-eyes (2052 +/- 264 cells/mm2) to the 33 control eyes (2372 +/- 276 cells/mm2), there was a significant reduction of cell density (p < 0.001). The cell density of the 69 PSX-eyes with glaucoma (2014 +/- 254 cells/mm2) was significantly lower than that of the 16 PSX-eyes without glaucoma (2214 +/- 251 cells/mm2) (p = 0.008). Eighty-five percent of the 85 PSX-eyes showed polymegalism, 77% pleomorphism; 68% had white deposits and 42% guttae. White deposits and guttae were significantly more frequent and more intensive in PSX-eyes than in control eyes. PSX-eyes with and those without glaucoma showed no significant differences concerning the four qualitative parameters.
Conclusion: The automated method for analysing corneal endothelium quickly provides reproducible and valid results using the correction mode of the software. Semiquantitative analysis of qualitative parameters permits a more differentiated assessment of keratopathy in pseudoexfoliation syndrome than does mere consideration of endothelial cell density. Both evaluations are recommended to assess the risk of a diffuse endothelial decompensation before intraocular surgery.