Abstract
The quantification of corneal endothelial cell (CEC) morphology using manual and semi-automatic software enables an objective assessment of corneal endothelial pathology. However, the procedure is tedious, subjective, and not widely applied in clinical practice. We have developed the CellsDeepNet system to automatically segment and analyse the CEC morphology. The CellsDeepNet system uses Contrast-Limited Adaptive Histogram Equalization (CLAHE) to improve the contrast of the CEC images and reduce the effects of non-uniform image illumination, 2D Double-Density Dual-Tree Complex Wavelet Transform (2DDD-TCWT) to reduce noise, Butterworth Bandpass filter to enhance the CEC edges, and moving average filter to adjust for brightness level. An improved version of U-Net was used to detect the boundaries of the CECs, regardless of the CEC size. CEC morphology was measured as mean cell density (MCD, cell/mm(2)), mean cell area (MCA, mu m(2)), mean cell perimeter (MCP, mu m), polymegathism (coefficient of CEC size variation), and pleomorphism (percentage of hexagonality coefficient). The CellsDeepNet system correlated highly significantly with the manual estimations for MCD (r = 0.94), MCA (r = 0.99), MCP (r = 0.99), polymegathism (r = 0.92), and pleomorphism (r = 0.86), with p < 0.0001 for all the extracted clinical features. The Bland-Altman plots showed excellent agreement. The percentage difference between the manual and automated estimations was superior for the CellsDeepNet system compared to the CEAS system and other state-of-the-art CEC segmentation systems on three large and challenging corneal endothelium image datasets captured using two different ophthalmic devices.