Effectiveness of in vivo confocal microscopy in detecting filamentous fungi during clinical course of fungal keratitis.
OBJECTIVE
To determine the effectiveness of laser confocal microscopy in detecting filamentous fungi in the cornea of patients with fungal keratitis (FK) and in evaluating the effectiveness of the treatment.


METHODS
The corneas of 6 patients clinically diagnosed with FK were examined with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Three of these patients were also monitored periodically with the HRT II-RCM after antifungal treatment.


RESULTS
The HRT II-RCM examination showed interlocking and branching, white, septated, hyphae-like lines in the cornea of all patients. All 6 patients had positive corneal smears and/or laboratory cultures. Three patients were monitored with HRT II-RCM after antifungal treatment. One patient, whose initial smear was negative, was diagnosed by HRT II-RCM before the positive culture results. In another case, the epithelial regeneration was impaired even 3 weeks after the initial treatment and HRT II-RCM revealed a mass of hyphae in the corneal ulcerated lesion. These findings indicated the necessity of surgical debridement. After the surgical debridement, the corneal epithelial defect was healed. HRT II-RCM was able to detect the morphological changes of hyphae after antifungal treatment and helped in the treatment modifications during the clinical course in all 3 patients.


CONCLUSIONS
These results indicate that HRT II-RCM can be used to diagnose FK and to monitor the effect of therapy on FK.
Takezawa
Yuki
Y
Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Shiraishi
Atsushi
A
Noda
Eriko
E
Hara
Yuko
Y
Yamaguchi
Masahiko
M
Uno
Toshihiko
T
Ohashi
Yuichi
Y
D000328:Adult; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D020231:Colletotrichum / Q000302:isolation & purification; D003315:Cornea / Q000382:microbiology / Q000473:pathology*; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003646:Debridement; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D010407:Penicillium / Q000302:isolation & purification; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents