Role of confocal microscopy in deep fungal keratitis

The purpose of this study was to assess the role of in vivo confocal microscopy in cases of fungal keratitis presenting with a deep stromal infiltrate.

Retrospective, noncomparative case series.

We reviewed the medical, microbiologic, and histopathologic data of 6 patients, whose clinical presentation was characterized by deep stromal or multifocal endothelial lesions. These patients were subjected to in vivo confocal microscopy on the day of presentation. All the patients underwent therapeutic penetrating keratoplasty. The excised corneal buttons were bisected and subjected to microbiologic and histopathologic examinations.

Microbiologic and/or histopathologic examination proved that the keratitis in all the 6 patients was caused by filamentous fungi. Five corneal buttons were positive for the fungus on histopathologic examination. Four specimens grew out fungus on microbiologic examination. In 5 (83%) cases, confocal microscopy revealed double-walled, septate, linear branching structures resembling fungal filaments.

In vivo confocal microscopy can be a useful diagnostic tool in patients presenting with deep stromal lesions.