Comparison of automated vs manual analysis of corneal endothelial cell density and morphology in normal and corneal endothelial dystrophy-affected dogs

Canine corneal endothelial cell analysis using vital dyes and light microscopy

PURPOSE

To evaluate the use of vital dyes and light microscopy for assessing canine corneal endothelial morphology ex vivo.

METHODS

The corneas of 40 canine eyes (n = 20 dogs) enucleated <24 h following euthanasia or death were isolated and flat-mounted on a slide. Corneal endothelium was stained via 0.25% trypan blue followed by 0.5% alizarin red (pH 4.2), photographed, then the following morphological features were calculated using ImageJ: mean cell density (MCD), mean cell area (MCA), polymegathism (coefficient of variation of cell area), and pleomorphism (% hexagonality).

RESULTS

Mean ± standard deviation (range) outcomes were: MCD, 2544 ± 541 cells/mm2 (1750-3922 cells/mm2); MCA, 431 ± 97 μm2 (251-626 μm2); polymegathism, 17 ± 2% (14%-22%); pleomorphism, 84 ± 3% (80%-90%). No significant differences (p ≥ .122) were noted for any outcome between male versus female or brachycephalic versus non-brachycephalic dogs. Young dogs (<10 years) had lower MCA (p = .044), lower pleomorphism (p = .003), and higher MCD (p = .035) when compared to older dogs (≥10 years). Age was significantly (p ≤ .049) correlated with MCA (r = 0.467), MCD (r = -0.476), polymegathism (r = 0.444), and pleomorphism (r = 0.609).

CONCLUSIONS

The combination of vital dyes and light microscopy allowed for clear visualization and evaluation of the corneal endothelium in canine eyes ex vivo. Our findings can be used in future studies to deepen our understanding of the corneal endothelium in health and disease.

Topical netarsudil for the treatment of primary corneal endothelial degeneration in dogs

This study evaluated the tolerability and efficacy of the topical rho-kinase inhibitor netarsudil for canine primary corneal endothelial degeneration (PCED). Twenty-six eyes of 21 client-owned dogs with PCED were enrolled in a prospective, randomized, vehicle control clinical trial and received topical netarsudil 0.02% (Rhopressa®) or vehicle control twice daily (BID) for the first 4 months. Then, all patients received netarsudil for the next 4 or 8 months. Complete ophthalmic examination, ultrasonic pachymetry, Fourier-domain optical coherence tomography, and in vivo confocal microscopy were performed at baseline and 1, 2, 4, 6, 8 and 12 months. Effect of netarsudil on central corneal thickness (CCT), percentage of cornea with edema, and endothelial cell density (ECD) were evaluated by repeated measures ANOVA. Kaplan-Meier curves and log-rank test were used to compare corneal edema and clinical progression of eyes in netarsudil versus vehicle control groups. All dogs developed conjunctival hyperemia in at least one eye while receiving netarsudil. Unilateral transient reticulated intraepithelial bullae and stromal hemorrhage were observed respectively in 2 dogs in the netarsudil group. Two dogs showed persistently decreased tear production while receiving netarsudil, requiring topical immunomodulatory treatment. No significant differences in CCT, ECD, corneal edema or clinical progression were observed between netarsudil or vehicle treated eyes. When comparing efficacy of topical netarsudil BID and topical ripasudil 0.4% administered four times daily from our previous study, dogs receiving ripasudil had significantly less progression than those receiving netarsudil.

A multicenter retrospective evaluation of the prevalence of known and presumed hereditary eye diseases in Lagotto Romagnolo dog breed within a referral population in Italy (2012-2020)

OBJECTIVE

To describe the ophthalmological findings of Lagotto Romagnolo dog breed and to report the prevalence of Known and Presumed Hereditary Eye Diseases (KP-HED).

ANIMALS STUDIED

Two hundred sixteen dogs were examined and included in this retrospective study.

PROCEDURES

Medical records of Lagotto Romagnolo dogs between 2012 and 2020 were included. Data about the ocular status were collected through ocular screening examinations (OSE) or clinical ophthalmic examinations (COE). The prevalence of each KP-HED was expressed as a function of the total number of the KP-HED in this referral population.

RESULTS

A total of 85 dogs (39.35%) were ophthalmologically healthy, ocular diseases presumably not hereditary were found in 43 dogs (19.91%), and 88 dogs (40.74%) were affected by one KP-HED. The most common KP-HEDs diagnosed were cataract (28/88; 31.82%), corneal endothelial dystrophy (17/88; 19.32%), retinal dysplasia (9/88; 10.23%), lens instability (7/88; 7.95%), progressive retinal atrophy (6/88, 6.82%), and keratoconjunctivitis sicca (6/88, 6.82%). Most of dogs with a KP-HED (77.27%, 68/88) were identified within COE group.

CONCLUSIONS

To the authors' knowledge, this is the first report of the prevalence of ocular disease in the Lagotto Romagnolo dog breed within a referral population in Italy. This study suggests a relatively high prevalence of KP-HED, with a characteristic late-onset presentation in some diseases. Many of these KP-HED's, lead to ocular pain and irreversible blindness, for this reason, the authors highlight the importance of aiming for an early diagnosis. Breeder's efforts and breeding programs should be directed at limiting such disorders.

An automatic approach for cell detection and segmentation of corneal endothelium in specular microscope

PURPOSE

Specular microscopy is an indispensable tool for clinicians seeking to monitor the corneal endothelium. Automated methods of determining endothelial cell density (ECD) are limited in their ability to analyze images of poor quality. We describe and assess an image processing algorithm to analyze corneal endothelial images.

METHODS

A set of corneal endothelial images acquired with a Konan CellChek specular microscope was analyzed using three methods: flex-center, Konan Auto Tracer, and the proposed method. In this technique, the algorithm determines the region of interest, filters the image to differentiate cell boundaries from their interiors, and utilizes stochastic watershed segmentation to draw cell boundaries and assess ECD based on the masked region. We compared ECD measured by the algorithm with manual and automated results from the specular microscope.

RESULTS

We analyzed a total of 303 images manually, using the Auto Tracer, and with the proposed image processing method. Relative to manual analysis across all images, the mean error was 0.04% in the proposed method (p = 0.23 for difference) whereas Auto Tracer demonstrated a bias towards overestimation, with a mean error of 5.7% (p = 2.06× 10^-8). The relative mean absolute errors were 6.9% and 7.9%, respectively, for the proposed and Auto Tracer. The average time for analysis of each image using the proposed method was 2.5 s.

CONCLUSION

We demonstrate a computationally efficient algorithm to analyze corneal endothelial cell density that can be implemented on devices for clinical and research use.