Flex center method versus center method for endothelial corneal evaluation in eye banking. A comparative analysis
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Flex center method versus center method for endothelial corneal evaluation in eye banking. A comparative analysis R. Villalba • A. Jime´nez • G. Forne´s M. Eisman • J. L. Go´mez Villagra´n
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Received: 10 July 2013 / Accepted: 27 February 2014 Springer Science+Business Media Dordrecht 2014
Abstract Specular microscopy can provide a noninvasive morphological analysis of the cornea endothelial cell layer. A variety of analysis programs are available to determine corneal endothelial quality. The flex-center endothelial analysis method (Konan Inc) is a newer technique including the outermost digitized cells and thus increases the number of cells for analysis. The aim of this study is to analyze whether the new flex-center method, increases the possibilities of corneal endothelium evaluation before implants. For this purpose 67 corneas were studied by both methods at the Eye Bank of the Tissue Establishment of Co´rdoba. Although we have found differences in the resulting of number of cells in the area analysed, no significant differences were found with respect to the endothelial cell count, coefficient of variation cell area, and the percentage of hexagonal cells recorded. Based on this data, both methods can be used satisfactorily in eye banking. Keywords Cornea Eye bank Endothelial evaluation Specular microscopy
R. Villalba (&) A. Jime´nez G. Forne´s M. Eisman J. L. G. Villagra´n Regional Blood Transfusion Center and Tissue Establishment (Andalusian Biobank), Avda. San Alberto Magno s/n, 14004 Co´rdoba, Spain e-mail: [email protected]
Introduction Many evaluation methods can be used for tissue study in eye banking. The slit lamp enables an accurate observation of the cornea, revealing earlier stages of pathology that are visible grossly. The epithelium is inspected for integrity and overall condition: specifically abrasions, defects and foreign bodies. The stroma is examined for overall clarity, the amount of oedema and stromal folding (Elisabeth et al. 2008). The slit lamp is also the most efficient and rapid means to determine the quality of the endothelial layer with respect to density of cells, the degree of cell uniformity, the intactness of the endothelial sheet and Descemet’s membrane, and the detection of cornea guttata, endothelial vesicles, Descemet’s tears, and stress fractures in the endothelial sheet from the trauma of excision. The majority of eye banks with organ culture storage methods use additional procedures of endothelial evaluation. These include phase contrast microscopy and transmitted light microscopy, often accompanied by intravital staining of the endothelial layer (Kirk and Hassard 1969). The condition of the corneal endothelium is central to evaluating the suitability of corneal tissue for keratoplasty. It is the primary layer responsible for the maintenance of corneal turgor and transparency (Baddon et al. 2010, Gaum et al. 2012). Specular microscopy allows for a reasonable determination of endothelial cell density, cell pleo
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