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In vivo confocal microscopy in fungal keratitis
Emmanuelle Brasnu1, Tristan Bourcier, Bénédicte Dupas
1Department of Ophthalmology III, Quinze-Vingts National Center of Ophthalmology, Paris, France.
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.
Conclusion:
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.
Insights
Early diagnosis of fungal keratitis is crucial. Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) confocal microscopy offers a rapid, non-invasive method to visualize fungal structures in the cornea, aiding early detection.
Area of Science:
- Ophthalmology
- Medical Imaging
- Mycology
Background:
- Fungal keratitis is a significant global cause of blindness, prevalent in developing nations.
- Increased Fusarium keratitis cases in contact lens wearers raise public health concerns, particularly in developed countries.
- Contact lens solutions have been linked to a rise in fungal keratitis infections.
Purpose of the Study:
- To demonstrate the utility of in vivo confocal microscopy using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) for early fungal keratitis diagnosis.
- To highlight the advantages of HRTII-RCM in identifying fungal elements within the cornea.
Main Methods:
- HRTII-RCM confocal microscopy was applied to five patients diagnosed with fungal keratitis.
- The technique was also used on three donor corneas experimentally contaminated with Fusarium solani, Aspergillus fumigatus, and Candida albicans.
Main Results:
- Microscopic analysis and cultures confirmed Fusarium solani in four cases and Candida albicans in one.
- HRTII-RCM imaging revealed distinct, high-contrast structures consistent with fungal hyphae (Fusarium, Aspergillus) and pseudofilaments (Candida) in the anterior corneal stroma of infected patients and donor corneas.
Conclusions:
- HRTII-RCM in vivo confocal microscopy is a novel, non-invasive diagnostic tool for fungal keratitis.
- This technique provides rapid, high-resolution imaging of fungal structures, facilitating early disease detection.
