Corneal Endothelial Cell Density Is Correlated With Birth Weight and Central Corneal Thickness

Low birth weights may indicate low corneal endothelial cell density, which can influence corneal morphology later in life.

Corneal endothelial cell density (ECD) is positively correlated with birth weight (BW), and ECD distribution is dependent upon sex, according to a findings of a study published in BMC Ophthalmology.

Researchers sourced data from the Nanjing Eye Study (NES),an ongoing population-based open cohort study. In 2019, children (N=1171) aged 82 to 94 months enrolled in primary schools in Eastern China underwent an eye examination and their guardians responded to a questionnaire about their child. The primary outcome was variation in corneal ECD.

The study population was aged mean 7.38±0.29 years, 54.3% were boys, ECD thickness was 2875.34±195.00 cells/mm2, central corneal thickness (CCT) was 546.57±33.02 mm, axial length was 22.98±0.79 mm, and BW was 3.31±0.51 kg.

Significant correlations were observed between ECD and BW (r, 0.09; P =.002) and with age (r, -0.07; P =.03), axial length (r, -0.07; P =.02), and central corneal thickness (r, 0.07; P =.01). The investigators report that girls had thicker ECDs than boys (P <.001).

In the multivariate linear regression analysis, ECD was found to increase by 36.16 cells/mm2 as BW increased by 1 kg (P =.001). Girls had a 54.41 cells/mm2 thicker ECD than boys (P <.001), and ECD increased by 0.44 cells/mm2 with every 1 mm increase in CCT (P =.01), according to the researchers.

Prenatal growth development might affect corneal morphology in childhood, adolescents, and adults.

Stratified by BW, ECD was 2785.81 cells/mm2 among the low BW group, increasing to 2879.71 cells/mm2 for normal BW, and 2899.82 cells/mm2 for high BW (P <.001).

“Children born with low BW had significantly lower ECD than those born with normal BW and high BW,” according to the investigators. “We speculate that prenatal growth development might affect corneal morphology in childhood, adolescents, and adults.”

The major limitation was the reliance on guardian recall of the child’s BW.

This study found that among healthy school children, corneal ECD thickness depended on BW, which is a newly associated factor with corneal ECD. In addition, ECD thickness was positively correlated with central corneal thickness and was thicker among girls compared with boys.


Wang Z, Zuo X, Liu L, et al. Corneal endothelial cell density and its correlation with birth weight, anthropometric parameters, and ocular biometric parameters in Chinese school children. BMC Ophthalmol. 2022;22(1):334. doi:10.1186/s12886-022-02561-1