A novel method for examining corneal endothelial cell morphology in infants

Previous studies suggest that central corneal endothelial cell density (ECD) decreases from 6,100 cells/mm2 in neonates to 3,100 cells/mm2 in 10-year-olds. Currently, there is very sparse data regarding ECD in young children as well as the trend in which ECD decreases during childhood. This is because young children were unable to comply with existing clinic-based specular microscopes. Hence, we developed a novel method of imaging young children intra-operatively to help establish age-specific normative data for ECD and hexagonality of cells (%HEX). Children were either imaged using our novel technique whilst under general anesthesia (GA) or awake in clinic using a child friendly technique. 58 children were recruited (mean age: 5.50; range: 0.44-10.36). Our cohort displayed a significant linear decrease in ECD with age (r= -0.56, P<0.001). No correlation was found between %HEX and age (r=-0.10, P=0.48). We show that using a modern specular microscope and a relatively simple technique, it is possible to collect images from young infants and children