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Bhaskar Gupta, Sohaib Riyaz Rufai, Ramez Borbara, Nicole Tan, James E Self; A prospective observational study of corneal endothelial cell morphology in children using specular microscopy in vivo. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1481.
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Previous studies suggest endothelial cell density decreases from 6,000 cells/mm2 in neonates to 3,000 cells/mm2 in 10-year-olds. However, these estimations are derived from studies of post mortem neonatal specimens and older compliant children, with very sparse data for children aged 6 or younger as they are unable to comply with existing clinic-based specular microscopes. This study aims to establish age-specific normal data in young children for endothelial cell density (ECD), average cell surface area (AVG), coefficient of variation (CV) and percentage of hexagonal cells (HEX) in children aged 0-13 years, employing our piloted imaging technique using specular microscopy in vivo.
Children aged 0-13 years listed for ophthalmic surgery under general anaesthesia (GA) or due for clinical appointments were recruited. Children under 3 years of age or unable to comply with the traditional method were imaged using our novel technique under GA in theatre; older, compliant patients were imaged in clinic using a child friendly technique. Central corneal endothelial specular microscopic images of each eye were taken during GA or in clinics using non-contact Nidek CEM-530 (Nidek, Aichi, Japan). Further image analysis was carried out on the CEM Viewer to ensure cells were correctly identified. Pearson’s correlation was performed to establish the relationship between age and ECD, AVG, CV and HEX.
151 children (mean age: 5.18; S.D. 1.76; range: 0.44-12.32 years) were recruited and imaged under GA (n=7) and in clinic (n=144). Pearson’s correlation detected a moderate negative correlation between ECD and age (r=-0.462, P<0.001) and a moderate positive correlation between AVG and age (r=0.460, P<0.001). CV and HEX did not demonstrate a significant correlation with age (CV: r=-0.101 P=0.216, HEX: r=0.095, P=0.245).
Our technique for specular microscopy is effective in young children. Our findings demonstrate ECD decreases and AVG increases after 3 years of age. More information of children between 0-3 years is required.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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