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In Vivo Confocal Microscopy as a Prognostic Indicator in Acanthamoeba Keratitis: Insights from a Retrospective Study

Yiping Han1, Yuan Wei1, Qiankun Chen1

  • 1Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China.

Pathogens (Basel, Switzerland)
|March 28, 2026
PubMed
Abstract

Insights

In vivo confocal microscopy (IVCM) can predict Acanthamoeba keratitis (AK) outcomes. Specific IVCM features like clustered cysts indicate poor prognosis, while target-like cysts suggest a better outcome for AK patients.

Area of Science:

  • Ophthalmology
  • Microbiology
  • Medical Imaging

Background:

  • Acanthamoeba keratitis (AK) is a severe microbial keratitis.
  • Early prediction of AK treatment outcomes is crucial for patient management.

Purpose of the Study:

  • To evaluate longitudinal changes in in vivo confocal microscopy (IVCM) features during AK treatment.
  • To develop a prognostic model for AK using baseline IVCM findings.

Main Methods:

  • Retrospective study of 59 AK patients with IVCM at baseline, 1, and 3 months.
  • Analysis of 14 morphological features to compare good vs. poor prognosis groups.
  • Prognostic modeling using baseline IVCM features with logistic regression and cross-validation.

Main Results:

  • Poor prognosis in AK was associated with double-walled cysts, trophozoites, clustered cysts, higher cyst density, and deeper stromal invasion.
  • Good prognosis in AK was linked to target-like cysts, immature dendritic cells, and mature dendritic cells.
  • Clustered cysts predicted poor prognosis (OR=2.98), while target-like cysts (OR=0.26) and mature dendritic cells (OR=0.37) were protective (AUC=0.883).

Conclusions:

  • IVCM serves as a quantitative tool for early AK outcome prediction and personalized treatment.
  • Higher cyst burden, clustered cysts, and stromal invasion indicate poorer AK prognosis.
  • Target-like cysts and mature dendritic cells suggest a better prognosis in AK patients.
Keywords:
Acanthamoeba keratitisin vivo confocal microscopymorphological featuresprognostic model

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