The role of Confocal Microscopy in evaluation and treatment of infectious keratitis

Abstract

AbstractPurpose To evaluate the role of in vivo confocal microscopy (IVCM) in the diagnosis and treatment of infectious keratitis.Methods 24 patients with keratitis were examined by slit‐lamp biomicroscopy and IVCM (HRT). All IVCM examinations were assessed for inflammatory activity and potential etiology. After obtaining baseline cultures, patients were treated as bacterial (10), viral (5), fungal (8) or Acanthamoeba (1) related keratitis based on clinical findings and IVCM.Results Primary outcome was clinical improvement, secondary outcome was correlation between IVCM findings and final culture. In 23 cases (9 bacterial, 5 viral, 8 fungal and 1 Acanthamoeba) clnical improvement was observed within 21 days whereas 1 patient worsened. In bacterial suspected group cultures were positive in 7 cases (70%), in viral none of the cultures were positive. Despite typical clinical image and IVCM findings and clinical improvement on adequate medication in fungal and Acanthamoeba suspected groups cultures remained negative.Conclusion Our study suggests that IVCM along with clinical evaluation can be a useful tool in early diagnosis and guided treatment of patients with infectious keratitis, until definitive culture results are available. However, a prospective clinical study is recommended to further study the role of IVCM in infectious keratitis.