Abstract
Purpose To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear. Methods IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared. Results On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 μm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology. Conclusions Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.
Highlights
Keratitis is a disease characterized by the occurrence of inflammatory infiltration within one or several layers of the cornea such as the epithelium, Bowman layer, corneal stroma, and endothelium with the Descemet membrane
Nonspecific moderate or severe pain, decreased visual acuity, photophobia, and eye surface irritation are subjective symptoms reported by patients with keratitis. e diagnosis is mainly based on physician’s clinical experience in addition to microbiological analysis results. e positive predictive value of physician’s clinical experience had been shown to be very variable depending on the etiology of the infection. e rate of positive culture in cases of infectious keratitis has varied widely between 40 and 70% due to a variety of limiting factors [3,4,5]
Delays in diagnosis and treatment are common, and there is a strong necessity to utilize new, reliable modalities in the diagnostic process of keratitis. Both optical coherence tomography and confocal microscopy are noninvasive imaging modalities, which were already proved to help in differential diagnosis, especially in cases of atypical or complex infectious keratitis [6,7,8,9]
Summary
Keratitis is a disease characterized by the occurrence of inflammatory infiltration within one or several layers of the cornea such as the epithelium, Bowman layer, corneal stroma, and endothelium with the Descemet membrane. Differential diagnosis of keratitis is a major challenge due to the frequent occurrence of similar clinical symptoms in both infectious and noninfectious inflammations. E rate of positive culture in cases of infectious keratitis has varied widely between 40 and 70% due to a variety of limiting factors [3,4,5] For these reasons, delays in diagnosis and treatment are common, and there is a strong necessity to utilize new, reliable modalities in the diagnostic process of keratitis. Delays in diagnosis and treatment are common, and there is a strong necessity to utilize new, reliable modalities in the diagnostic process of keratitis Both optical coherence tomography and confocal microscopy are noninvasive imaging modalities, which were already proved to help in differential diagnosis, especially in cases of atypical or complex infectious keratitis [6,7,8,9]. Differential diagnosis with other infectious and aseptic inflammations is required [12]
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