Fungal keratitis - improving diagnostics by confocal microscopy.
OBJECTIVE
Introducing a simple image grading system to support the interpretation of in vivo confocal microscopy (IVCM) images in filamentous fungal keratitis.


METHODS
Clinical and confocal studies took place at the Department of Ophthalmology, Aarhus University Hospital, Denmark. Histopathological analysis was performed at the Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.


METHODS
A recent series of consecutive patients with filamentous fungal keratitis is presented to demonstrate the results from in-house IVCM. Based upon our experience with IVCM and previously published images, we composed a grading system for interpreting IVCM images of filamentous fungal keratitis.


RESULTS
A recent case series of filamentous fungal keratitis from 2011 to 2012 was examined. There were 3 male and 3 female patients. Mean age was 44.5 years (range 12-69), 6 out of 17 (35%) cultures were positive and a total of 6/7 (86%) IVCM scans were positive. Three different categories of IVCM results for the grading of diagnostic certainty were formed.


CONCLUSIONS
IVCM is a valuable tool for diagnosing filamentous fungal keratitis. In order to improve the reliability of IVCM, we suggest implementing a simple and clinically applicable grading system for aiding the interpretation of IVCM images of filamentous fungal keratitis.
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark.
E
E
Nielsen
Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark ; Department of Ophthalmology, Glostrup Hospital, Glostrup, Aarhus University Hospital, Skejby, Denmark.
S
S
Heegaard
Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark.
J U
JU
Prause
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark.
A
A
Ivarsen
Department of Clinical Microbiology and Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
K L
KL
Mortensen
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark.
J
J
Hjortdal
Diagnostics; Fungal keratitis; In vivo confocal microscopy