Comparison of endothelial cell count using confocal and contact specular microscopy

Precise examination of the corneal endothelium has become increasingly important due to the growing number of intraocular and corneal procedures. The purpose of this study was to compare prospectively the corneal endothelial cell count in normal eyes obtained by confocal and specular microscopy. Central corneal endothelial cell densities of 42 eyes from 42 patients were measured by confocal and contact specular microscopy. Endothelial cells were analyzed with the same software in a manual, an automated and a semi-automated mode. The mean endothelial cell density obtained by confocal microscopy was (in the manual, automated and semi-automated modes) 3,069 +/- 285, 2,791 +/- 344 and 3,077 +/- 286 cells/mm(2), and obtained by specular microscopy 3,076 +/- 298, 2,796 +/- 271 and 3,082 +/- 282 cells/m(2), respectively. No statistically significant difference of endothelial cell density between confocal and specular microscopy was found. Endothelial cell count was significantly lower in the automated than in the semi-automated and manual analysis both with confocal and with specular microscopy. In conclusion, endothelial cell count measurements with confocal and contact specular microscopy are comparable.