J Korean Ophthalmol Soc.  2008 Oct;49(10):1572-1577.

Comparision of Specular Microscopy and Confocal Microscopy for Evaluation of Corneal Endothelium

  • 1Department of Ophthalmology, Seoul Adventist Hospital, Seoul, Korea.
  • 2Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. eyedoc@catholic.ac.kr


To compare the results of specular microscopy with those of confocal microscopy for evaluation of corneal endothelium.
We evaluated corneal endothelium of 103 eyes using specular microscopy and confocal microscopy. Endothelial cell density, pleomorphism, and polymegathism were measured using a ConfoScan 4 confocal microscope (Nidek Technologies, Inc, Greensborom, NC) in automatic mode before and after manual correction. Also, endothelial cell density, the coefficient of variation, and hexagonality were evaluated using a Konan Noncon Robo-8400 noncontact specular microscope (Konan medical, Inc., Hyogo, Japan). The differences in results obtained from these various methods were compared: polymegathism was compared with the coefficient of variation, and pleomorphism was compared with the inversion of hexagonality.
Endothelial cell density as measured by specular microscopy, the automatic count of confocal microscopy, and the manual correction for confocal microscopy were 2797.6+/-354.14 cell/mm2, 2973.1+/-284.24 cell/mm2, and 2861.9+/-335.58 cell/mm2, respectively. Results of each test was not significantly different (p=0.241). The inversion of hexagonality, pleomorphism of automatically counted confocal microscopy, and the pleomorphism of manually corrected confocal microscopy were 56.14%, 54.77%, and 55.24%, respectively. Results of each test were not significantly different (p=0.147).The coefficient of variation of specular microscopy, the polymegathism of automatic counted confocal microscopy, and the polymegathism of manually corrected confocal microscopy were 33.71%, 39.68%, and 38.75%, respectively. Results of each test were significantly different (p=0.005).
Endothelial cell density and polymegathism as measured by confocal microscopy were not different from specular microscopy results in normal corneas, but these results were different for polymegathism in normal corneas. Therefore, manual correction for endothelial cell evaluation of a disordered cornea should be performed during clinical evaluation.


Confocal microscopy; Corneal endothelium; Specular microscopy

MeSH Terms

Endothelial Cells
Endothelium, Corneal
Microscopy, Confocal



1. Maurice DM. Davson H, editor. The cornea and sclera. The eye. 3rd ed. New York: Academic Press;1984. v. 1b.:p. chap. 2.
2. Burns RR, Bourne WM, Brubaker RF. Endothelial function in patients with cornea guttata. Invest Ophthalmol Vis Sci. 1981; 20:77–85.
3. Mustonen RK, McDonald MB, Srivannaboon S. . In vivo confocal microscopy of Fuchs’ dystrophy. Cornea. 1998; 17:493–503.
4. Wilson SE, Bourne WM. Fuchs’ dystrophy. Cornea. 1988; 7:2–18.
5. Adamis AP, Filatov V, Tripathi BJ. . Fuchs’ endothelial dystrophy of the cornea. Surv Ophthalmol. 1993; 38:149–68.
6. Mandell RB, Polse KA, Brand RJ. . Corneal hydration control in Fuchs’ dystrophy. Invest Ophthalmol Vis Sci. 1989; 30:845–52.
7. Wilson SE, Bourne WM, O’Brien PC, Brubaker RF. Endothelial function and aqueous humor flow rate in patients with Fuchs’ dystrophy. Am J Ophthalmol. 1988; 106:270–8.
8. Kaufman HE, Capella JA, Robbins JE. The human corneal endothelium. Am J Ophthalmol. 1966; 61:835–841.
9. Capella JA. The pathology of corneal endothelium. Ann Ophthalmol. 1971; 3:397–400.
10. Maurice DM. Cellular membrane activity in the corneal endothelium of the intact eye. Experientia. 1968; 21:1094–5.
11. Chiou AG, Kaufman SC, Beuerman RW. . Confocal microscopy in cornea guttata and Fuchs’ endothelial dystrophy. Br J Ophthalmol. 1999; 83:185–9.
12. Hara M, Morishige N, Chikama T, Nishida T. Comparion of confocal biomicroscopy and noncontact specular microscopy for evaluation of the corneal endothelium. Cornea. 2003; 22:512–5.
13. Mayer F, Dighiero R. . Confocal microscopy of cystic disorder of corneal epithelium. Ophthal mology. 1998; 105:631–6.
14. Lemp MA, Dilly PN, Boyde A.Tandem scanning (confocal) microscopy of the full thickness cornea. Cornea. 1985-6; 4:205–9.
15. Cavanagh HD, Petroll WM, Alizadeh H. . Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease. Ophthalmology. 1993; 100:1444–54.
16. Sheppard C Jr, Wilson T. The theory of the direct-view confocal microscope. J Microsc. 1981; 124:107–17.
17. Brakenhoff GJ, van der Voort HT, van Spronsen EA, Nanninga N.Three-dimensional imaging by confocal scanning fluorescence microscopy. Ann N Y Acad Sci. 1986; 483:416–27.
18. Wiegard W, Thaer AA, Kroll P. . Optical sectioning of the cornea with a new confocal in vivo slit-scanning video microscope. Ophthalmology. 1995; 102:568–75.
19. Kim SY. Korea external eye disease society. Cornea. 2nd ed. Seoul: Ilchogak;2006. p. 34.
20. Imre L, Nagymihaly A. Reliability and reproducibility of corneal endothelial analysis by in vivo confocal microscopy. Graefes Arch Clin Exp Ophthalmol. 2001; 239:356–60.
21. Klais CM, Bühren J, Kohnen T. Comparision of endothelial cell count using confocal and contat specular microscopy. Ophthalmologica. 2003; 217:99–103.
22. Kitzmann AS, Winter EJ, Nau CB. . Comparision of corneal endothelial cell images from a noncontact specular microscope and a scanning confocal microscope. Cornea. 2005; 24:980–4.
23. Kim KS, Park YK. Assessment of the reproducibility of corneal endothelial cell analysis with non contact specular microscope. J Korean Ophthalmol Soc. 1998; 39:70–5.
24. Waring GO III, Bourne WM, Edelhauser HF, Kenyon KR. The corneal endothelium; normal and pathologic structure and function. Ophthalmology. 1982; 89:531–90.
Full Text Links
  • JKOS
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr