In vivo confocal microscopy in fungal keratitis.
BACKGROUND
Fungal keratitis is a major blinding eye disease found throughout the world, particularly in developing countries. Given the recent increase in Fusarium keratitis infections in contact lens wearers owing to contact lens solutions, a warning was recently issued by the Food and Drug Administration, making it a public health concern in developed countries.


OBJECTIVE
To show the advantages of in vivo confocal microscopy imaging using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) in the early diagnosis of fungal keratitis.


METHODS
HRTII-RCM confocal microscopy was performed on five patients presenting with fungal keratitis and on three donor corneas contaminated with Fusarium solani, Aspergillus fumigatus and Candida albicans.


RESULTS
Direct microscopic evaluation of corneal smears and culture revealed the presence of F solani in four cases and C albicans in one case. HRTII-RCM examination of the infected patients and contaminated donor corneas revealed numerous high-contrast elements resembling Fusarium, Aspergillus hyphae or Candida pseudofilaments in the anterior stroma.


CONCLUSIONS
HRTII-RCM in vivo confocal microscopy is a new, non-invasive and rapid technique for the early diagnosis of fungal keratitis, showing high-resolution images resembling fungal structures in the early phase of the disease.
Brasnu
Emmanuelle
E
Department of Ophthalmology III, Quinze-Vingts National Center of Ophthalmology, Paris, France.
Bourcier
Tristan
T
Dupas
Bénédicte
B
Degorge
Sandrine
S
Rodallec
Thibault
T
Laroche
Laurent
L
Borderie
Vincent
V
Baudouin
Christophe
C
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015821:Eye Infections, Fungal / Q000473:pathology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged