Corneal Cell Counting

Corneal cell counting is a non-invasive test to analyze corneal cell numbers and morphology. While the morphology of corneal cells can be analyzed by several methods, corneal cell numbers or the density of corneal cells can only be estimated with tools possessing magnifying capacity. Based on different principles of reflection and magnification, these tools provide a quick and reliable approach to estimate corneal cell count.

What Is Corneal Cell Counting?

Corneal cell counting is a type of diagnostic test that estimates the density of corneal cells forming the corneal membrane. It is performed under high magnification by two types of magnifying tools.

Specular microscope:

This is the preferred clinical tool that allows a precise and accurate method for corneal cell counting. It can determine corneal cell morphology including number, size, density, and distribution. It can also detect polymegathism, which is a permanent change in corneal cell morphology due to the chronic use of contact lenses. Furthermore, it can also detect corneal cell polymorphism, which is the presence of variation in the shape of the cells.

Confocal microscope:

This is a similar tool that allows equivalent accuracy in analyzing the corneal cell count and morphology. It is preferred over the specular microscope in case of corneal edema, where the specular microscope is inefficient to use.

Indications of Corneal Cell Counting

Corneal cell counting is useful in making the diagnosis of different types of corneal dystrophies. In long-term contact lens wearers, corneal cell counting is recommended to monitor adequate cell density and morphology. 

Apart from accidental injuries, there are other conditions that can lead to endothelial cell damage. Specular microscopy analyzes corneal cell morphology and can thus help know the timing of when a corneal transplant is indicated. There are several conditions that fall under indications of corneal cell counting such as:

  • Fuchs’ endothelial corneal dystrophy
  • Posterior polymorphous corneal dystrophy
  • Congenital hereditary endothelial dystrophy
  • Glaucoma
  • Chandler’s syndrome
  • Uveitis
  • Intraocular surgery
  • Diabetes
  • Keratoconus
  • Eye inflammation
  • Eye injuries
  • Assessment of donor corneal status
  • Aging
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What Can You Expect While Undergoing Corneal Cell Counting?

Specular microscope is commonly found in most settings, be it an eye bank or an eye clinic. It is a computerized magnifying device mounted on a table.

Since it is a non-invasive test and can be performed quickly, it is not bothersome to the patient. However, you must warn your examiner in case of any inconvenience.

1. The patient is asked to comfortably sit facing the microscope. The patient’s chin is then placed on a chin stand with their forehead supported by a forehead stand. One eye is examined at a time.
2. The examiner takes a few close shots of each of the patient’s eyes. The display unit shows the magnified version of the images of hexagonal corneal cells.
3. The examiner then analyzes the morphology with various software-based techniques.
Advantages Of Corneal Cell Counting

The cornea is the transparent anterior surface of the eyeball. Several anatomical and physical factors come into play to maintain the transparency of the cornea. The innermost layer out of the five layers of the cornea is called the endothelium. Millions of cells are arranged in such a unique fashion that is responsible for the transparency of the corneal surface. These cell counts gradually decline with age. Since they lack regenerative capacity, the remaining cells compensate for the optimum function of the cornea.

Sometimes, other conditions may also result in the destruction of cornea, disrupting these cells. Such disruption will not only compromise the transparency of the eyes, but the refractive power of the eyes will be jeopardized as well. Corneal cell counting techniques help to identify any pathologies within these cells, allowing early intervention.

Rapid and accurate cell count
Non-invasive and hazard-free
Ability to examine donor cornea stored in storage media
Additional features including corneal thickness measurement
Easy to perform in any setting

Limitations Of Corneal Cell Counting

Corneal cell counting can be done in both contact and non-contact methods. Due to many limitations of the contact method, modern corneal cell counting tools involve a non-contact approach. Despite this, the widely used specular microscope can have some limitations such as:

  • Difficult to perform in case of corneal edema
  • Error results with coexisting Descemet’s folds
  • Allows only two-dimensional view of corneal cells

The Takeaway

Corneal cell counting is the process of estimating the number, density, and morphology of corneal cells. It can be done either by specular microscopy or confocal microscopy, although specular microscopy is the preferred one. Corneal cells lack regenerative capacity; hence, early detection and monitoring of conditions associated with corneal cell count can halt further worsening. Corneal cell counting, apart from its indication in different conditions, is also a useful tool in eye banks. 

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