Comparison of Donor Cornea Endothelial Cell Density Determined by Eye Banks and by a Central Reading Center in the Cornea Preservation Time Study

Beth Ann Benetz, Christopher G. Stoeger, Sanjay V. Patel, Robert C. O'Brien, Loretta B. Szczotka-Flynn, Allison R. Ayala, Maureen G. Maguire, Harry J. Menegay, Peter Bedard, Jameson M. Clover, Pankaj C. Gupta, Kristen E. McCoy, Jonathan C. Song, Jonathan H. Lass

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


PURPOSE: To evaluate agreement between eye banks (EBs) and a reading center on endothelial cell density (ECD) determinations in the Cornea Preservation Time Study.

METHODS: The Cornea Image Analysis Reading Center (CIARC) performed variable frame image analysis on EB-obtained-preoperative central endothelial images (after lamellar dissection for Descemet stripping automated endothelial keratoplasty by the EBs or before shipping, if surgeon prepared) to determine ECD. The EBs performed their usual method of ECD determination. The CIARC and EBs also provided ECD determinations from screening central endothelial images taken by the EBs during donor evaluation. Two independent masked CIARC readers determined ECD with measurements averaged.

RESULTS: The mean preoperative ECD was 15 cells/mm greater by the EBs than by CIARC (N = 1286, P < 0.001) with 95% limits of agreement of (-644, 675 cells/mm). The limits of agreement in preoperative ECD were wider in the After-Lamellar-Dissection Group (-687, 683 cells/mm) than in the Before Shipping Group [(-505, 633 cells/mm); P = 0.03]. The EBs-determined preoperative ECD was within 10% of the CIARC-determined ECD for 886 (69%) image sets, with 236 (18%) higher by >10% and 164 (13%) lower by >10%. Excellent agreement appeared between the EBs and CIARC when 100-300 cells could be analyzed in contrast to <100 cells (SD = 308 cells/mm vs. SD = 603 cells/mm; P < 0.001).

CONCLUSIONS: The mean ECD by the EBs and CIARC were similar, but there was considerable variability between determinations for individual corneas. Agreement improved between the 2 measurements when more than 100 cells were able to be analyzed.

Original languageEnglish (US)
Pages (from-to)426-432
Number of pages7
Issue number4
StatePublished - Apr 1 2019

Bibliographical note

Funding Information:
Supported by cooperative agreements with the National Eye Institute, National Institutes of Health, Department of Health and Human Services EY20797 and EY20798.

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.


  • endothelial keratoplasty
  • reading center
  • specular microscopy
  • Descemet Stripping Endothelial Keratoplasty
  • Humans
  • Image Processing, Computer-Assisted/statistics & numerical data
  • Middle Aged
  • Male
  • Cell Count/methods
  • Young Adult
  • Endothelium, Corneal/cytology
  • Eye Banks/statistics & numerical data
  • Adolescent
  • Adult
  • Female
  • Aged
  • Corneal Endothelial Cell Loss/diagnostic imaging
  • Child

PubMed: MeSH publication types

  • Journal Article


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