Validation Of A Deep Learning-Assisted Evaluation Of Total Corneal Endothelial Cells Viability
Published 2025 - 43rd Congress of the ESCRS
Reference: FP07.03 | Type: Free paper | DOI: 10.82333/ncds-5g12
Authors: Leon Au* 1 , Keith Barton 2 , Robert Chang 3 , Signe Erickson 3
1Glaucoma and Cornea,Manchester Royal Eye Hospital,Manchester,United Kingdom, 2Glaucoma Service,Moorfields Eye Hospital,London,United Kingdom;Ophthalmology,University College London,London,United Kingdom, 3Myra Vision,Campbell, CA,United States
Purpose
To describe the validation of a novel automated analysis of preoperative pan-corneal endothelial cell viability
Setting
Pre-clinical eye bank experimental study. Corneoscleral rims deemed unsuitable for transplantation and destined for research purposes at the Veneto Eye Bank Foundation were used for this study.
The main outcome of the study was the correlation and agreement of endothelial mortality estimations between the V-CHECK method and manual gold standard method.
Methods
Corneoscleral rims were stained with Trypan Blue 0.05% to highlight dead endothelial cells and denuded areas of Descemet membrane. Endothelial mortality was estimated through manual counting by an experienced eye bank technician (“gold standard”) and by deep learning-aided automated segmentation of Trypan Blue Positive Areas (TBPAs) on images of the stained corneas acquired through a surgical microscope (“V-CHECK method”). V-CHECK mortality was calculated for the whole cornea and for concentric 2-mm rings centred on the corneal centre. The agreement in the estimation of endothelial mortality between the two methods was assessed with Bland-Altmann analysis and correlation tests.
Results
A total of 19 corneas deemed unsuitable for transplantation were used for the experiment. The automated V-CHECK method accurately and reproducibly segmented the corneal endothelium and the TBPAs. The gold standard and the V-CHECK method showed strong positive correlation for all rings (Pearson’s ρ, range [0.76 – 0.81], all p < 0.001). The V-CHECK method resulted in higher average estimated endothelial mortality (mean difference range [+6.5% - +9.5%]).
Conclusions
The V-CHECK method enables reproducible estimation of endothelial cell viability in donor corneas. Incorporating this technique into the preoperative assessment of donor corneal tissues – in the eye bank and in the operating theatre – can offer eye bank technicians and corneal surgeons a reliable evaluation of endothelial health, thereby improving the consistency of tissue quality and further supporting optimal surgical results.