Endothelial cell density determined by specular microscopy and scanning electron microscopy.

Human eyes were photographed with a specular microscope and later examined wit a scanning electron microscope. Corneas from patients undergoing corneal transplantation in whom we were able to obtain preoperative specular micrographs were similarly analyzed. An attempt was made to correlate the counts obtained with both microscopic techniques by determining the amount of shrinkage the cornea undergoes while being processed for SEM. All specimens were counted with a planimeter. We found that the specular microscope adequately analyzes the endothelial cell density in the central and paracentral cornea of a normal eye, but because of its small sampling area specular microscopic counts are subject to significant error when dealing with nonhomogeneous populations such as postoperative cases. We found the peripheral corneal endothelial density to be less than the central endothelial density. Furthermore, we found that we could maximize the accuracy of counting by using a variable frame in a nonhomogeneous population, counting a minimum of four photographs per specimen, analyzing different areas, and analyzing larger areas.