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Research Letter |

Validation of Corneal Endothelial Specular Microscopy in Children Under General Anesthesia

Uri Elbaz, MD1; Kamiar Mireskandari, MBChB, FRCSEd, FRCOphth, PhD1; Caitriona Kirwan, MB, BCh, FRCSI(Ophth)1; Asim Ali, MD, FRCSC1
[+] Author Affiliations
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
JAMA Ophthalmol. 2015;133(12):1474-1476. doi:10.1001/jamaophthalmol.2015.3695.
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This case series compares the use of corneal endothelial specular microscopy in children under anesthesia with that in children who are awake.

Our current knowledge of the corneal endothelium in early childhood including its development and response to disease and surgery is suboptimal,13 largely owing to the technical difficulties involved in obtaining specular microscopy (SM) images in very young patients. The gold-standard technique for SM is to acquire images with central fixation while the patient is alert and upright, enabling images of the same corneal region each time. We have modified this technique to capture SM images in children under general anesthesia (GA) who are positioned in the lateral decubitus position with centration of the eye in the display reticle. However, because the patient is not able to fixate on a target, it is not clear whether this acquisition technique is reproducible.

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Bland-Altman Analyses

Bland-Altman analyses of agreement between intrasession measurements (images 1A and 1B) (A), between intersession measurements (images 2 and 3) (B), and between fixating vs nonfixating eye measurements (C). ECD indicates endothelial cell density; solid line, mean difference; and dotted lines, ±1.96 SDs from the mean (95% limits of agreement).

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