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Corneal Endothelial Cell Density in Children: Normative Data From Birth to 5 Years Old
Uri Elbaz1, Kamiar Mireskandari1, Nasrin Tehrani1
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Endothelial cell density (ECD) rapidly declines in the first two years of life, correlating with corneal diameter growth. After age two, ECD decreases similarly to adults, establishing normative data for pediatric eye care.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Science
Background:
- Endothelial cell density (ECD) is crucial for corneal health and clarity.
- Normative data for pediatric ECD is limited, hindering clinical assessment.
- Specular microscopy is a standard technique for measuring ECD.
Purpose of the Study:
- To establish a normative database of endothelial cell density (ECD) in children under 5 years old.
- To analyze the relationship between ECD, corneal diameter (CD), and age in young children.
Main Methods:
- A cross-sectional study involving 118 children under 5 years old.
- In vivo specular microscopy was performed in cooperative and uncooperative children (under general anesthesia).
- Corneal diameter (CD) was measured and stratified by age.
Main Results:
- The mean ECD was 3746 ± 370 cells/mm².
- ECD showed a stronger inverse correlation with CD than age up to 2 years (r=-0.61).
- After age 2, ECD inversely correlated with age (r=-0.27) but not CD, with a significantly faster decline in the first year of life.
Conclusions:
- A rapid decline in ECD occurs in the first two years, likely due to corneal growth.
- Post-two years, ECD decreases at a rate comparable to adults.
- This study provides essential normative ECD data for pediatric ophthalmology.
Purpose:
To establish a normative database of endothelial cell density (ECD) using in vivo specular microscopy in children under 5 years old.
Design:
Cross-sectional study.
Methods:
Specular microscopy was performed during a clinic visit in cooperative children in the standard upright position. In uncooperative children, specular microscopy was performed in the lateral decubitus position under general anesthesia, before surgery for other reasons. Corneal diameter (CD) was measured in children undergoing general anesthesia and was stratified according to age.
Results:
One hundred and eighteen eyes of 118 patients were included in the study. The mean patient age was 2.6 ± 1.4 years (range 0.1-5 years) and the mean ECD was 3746 ± 370 cells/mm2 (range 3145-5013 cells/mm2). The mean CD under 2 years of age was 11.85 ± 0.57 mm (n = 40, range 10.50-12.75 mm). Up to 2 years of age, ECD was more inversely correlated with CD than with age (r = -0.61, P < .0001; r = -0.38, P = .01, respectively). In contrast, after the age of 2 years, the ECD was inversely correlated with age but not with CD (r = -0.27, P = .02; r = -0.24, P = .2). Between the first and second year of life, the rate of ECD decrease was significantly higher than between 2 and 5 years of age (8.2%, 334 cells/mm2 vs 2.7%, 100 cells/mm2 a year, respectively).
Conclusion:
In the first 2 years of life there is a rapid decline in ECD, which is likely related to growth in CD and hence surface area. After the cornea reaches adult size, the ECD decreases at a rate similar to that reported in adults.
