Clinical assessment of corneal endothelial cell density: an original system of grading using a slit-lamp biomicroscope.

An original system of grading of the corneal endothelial specular reflection, as assessed with a Haag-Streit 900 slit-lamp biomicroscope, has been shown to have a very highly significant relation to the endothelial cell density measured by contact specular photomicroscopy. The grading, though subjective and therefore not a substitute for the detailed record of photomicroscopy, is readily applicable to clinical practice and is a useful method of comparing and recording endothelial cell densities when assessed by the same observer. The intraobserver, but not the interobserver, variability has been examined, and the theoretical aspects of the grading system and a clinically applicable interpretation of the grading are presented.