The EBAI CME 2013 - 21st and 22nd of September 2013, Golden Valley Resort, Ghodbunder Road, Thane West, Mumbai.

3.  Corneal Endothelial Anatomy
 Purpose of doing Specular Microscopy
 Instrumentation (Eye Bank specular)
 Basic Procedures
 Normal and Abnormal
 Conclusions

5.  Cell count of a Tissue
 Quality of Tissue
 Good cell count is essential before Corneal
Transplant
 Shape variability (pleomorphism)
 Size variability (polymegathism)

6. Here the Cornea been placed for the Specular cell count

7. Nob Adjustor

8. HAI LAB SPECULAR
MICROSCOPE
KONAN KERATO ANALYZER

11. Features
Long time procedure
No visual display
Only one field can be taken
Donor Information Data to be given

12. Features
Easier to handle
 Digital data shown with
VDM ( Visual Display
Monitor )
Four fields can be taken
for analysis
Print out can be taken

13. Life 4C
M.K. Medium
Eusol-C

14. Terminology

19. Fuch’s
Dystrophy

22.  Obtain image prior to storage at 2-8 °C if
possible
 After storage, warm for at least one hour
at room temperature
 If cells are misshapen or image quality is
poor, warm longer and repeat
 Strive for “good” or better quality images

23. STEPS FOR SPECULAR

25. When: as soon as possible
 Delay results in poorer images
 Immediately after laboratory excision if whole
globe procured
12 hours post-mortem 4 days post-mortem

26. 4 degrees C
20 degrees C

27. CELL DENSITYNORMAL CELL

29.  Accurate endothelial cell density (ECD)
 Pre-cut tissue: pre- and post-cut ECD
 Presence of cell size or shape variability
 Evidence of endothelial disease

30.  Counting errors
 Inadequate boundary tracing
 Poor image quality

31. Fixed Frame Analysis
More prone to error
Should be abandoned
Variable Frame Analysis
More accurate (if done properly)
Preferred method

32. Poor image quality makes tracing, sampling difficult

33. Correct: all cells within boundary
counted once
Incorrect: failure to count all cells
results in low cell count

34. Poor cell border
definition makes
counting difficult
Dark areas: are these cells?

35. Excellent Good
Fair Poor

36. Eyebank-specific findings:
•Forceps trauma may mimic guttae
•Corneal “stress lines” induced by corneal
folding during excision may mimic guttae
•Folds from edema/cooling

37. Forceps Trauma
Stress lines from folding

38. Pleomorphism, Polymegathism
Fold from edema

39.  Every Technician / Staffs of Eye Bank should
be well trained to handle Specular
Microscope.
 Always bring the tissue in room temperature
for better result.
 Tissues must be handle with care.
 Every Year calibration of Specular Microscope
is required.