Morphological characteristics of corneal endothelial cells in a healthy southern Han Chinese population across the entire life cycle and evaluation of age-associated endothelial morphological indicators
In brief
Corneal endothelial cell density falls 0.42% yearly in healthy southern Han Chinese
In specular microscopy of 13,820 healthy southern Han Chinese volunteers aged 3 to 99, endothelial cell density declined by an estimated 0.42% per year of age, while corneal thickness showed no significant age association. Hexagonality tracked age most sensitively, and cell-size variability and largest-cell size were the most consistent indicators of age-related shape changes; these cross-sectional findings do not establish clinical biomarkers.
- Journal
- Frontiers in medicine (Q1)
- Published
- 8 October 2026
- Study design
- Cross-sectional study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Jundong Zhu, Qi He, Pu Zhang, Cheng Li, Zhiyuan Li
- PMID
- 42922841
- DOI
- 10.3389/fmed.2026.1860522
Why clinicians should know about it
- Picked for Histology (paper of the day, 26 October 2026): Large healthy cohort quantifies endothelial cell morphology across ages
Abstract
OBJECTIVE: The study aimed to observe the morphological changes in corneal endothelial cells in a healthy Han Chinese population in southern China over the entire life cycle, analyze age-associated morphological changes, and evaluate the potential utility of endothelial assessment parameters as candidate biomarkers. METHODS: In total, 13,820 healthy Han Chinese volunteers were examined by specular microscopy, and the endothelial descriptive indexes, including central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in average cell size (CV), percentage of regular hexagonal cells [hexagonality (HEX)], size of the smallest cell (Smin), size of the largest cell (Smax), average cell size (Savg), and cell area standard deviation (Ssd), as well as gender and age, were analyzed. RESULTS: The average age of the participants in this study was 48.14 ± 23.47 (3-99) 14;years. There was no sex predominance, with 6,836 male participants (46.38%) and 6,984 female participants (53.62%). The mean CCT, ECD, CV, HEX, Smin, Smax, Savg, and Ssd were 524.95 ± 34.2 14;μm (415-650 14;μm), 2,843.15 ± 393.84 14;cells/mm2 (1,501-4, 180 14;cells/mm2), 32.07% ± 5.71% (16%-60%), 54.17% ± 12.87% (12%-99%), 146.30 ± 33.81 14;μm2, 790.60 ± 182.74 14;μm2, 357.92 ± 57.92 14;μm2, and 115.71 ± 33.05 14;μm2, respectively. CCT was not significantly associated with age (p = 0.061). The cross-sectional age-associated ECD decline was estimated at 0.42% per year of age (95% CI: 0.39%-0.45%). The ECD and hexagonality curves expressed the same linear trend. The CCT and endothelial evaluation indexes had no gender predominance (p > 0.05). ECD and HEX were significantly negatively associated with age (p = 0.001 or p < 0.001). CV, Smin, Smax, Savg, and Ssd were positively correlated with age (p < 0.001). Finally, CCT was not significantly associated with age (p = 0.061>0.05). CONCLUSIONS: This study found that the ECD decrease rate was 0.42%/year for a healthy Han Chinese population in southern China during the entire life cycle. HEX showed the strongest age-associated sensitivity to morphological changes, while Smax and CV demonstrated the most consistent age-related specificity as morphological indicators of endothelial polymegathism and pleomorphism in the specular microscopy results.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.