In vivo confocal microscopy in fungal keratitis

Abstract

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.

Antifungal chemotherapy for fungal keratitis guided by in vivo confocal microscopy

“…It has frequently been used in the diagnosis and monitoring of fungal keratitis [12][13][14]. In this study, we used confocal microscopy to evaluate the therapeutic effects of antifungal chemotherapy, and to guide the administration of antifungal medications.…”

Fusarium keratitis and endophthalmitis associated with lens contact wear

“…Besides microbial assessments, high-resolution images of the fungal structures using in vivo confocal microscopy is a valuable tool for diagnosis and monitoring. Brasnu et al [28], using the Heidelberg Retinal Tomograph II-Rostock Cornea Module (HRTII-RCM), showed a high correlation between images of fungal hyphea and results of cultures. In the future, this exam may be used for an earlier and more accurate diagnosis of fungal corneal infections, as we made in this case.…”

Application of fluorescent indicators to analyse intracellular calcium and morphology in filamentous fungi

“…Indeed, these innovations have had a profound impact on the analysis and understanding of living fungal hyphae at the cellular and molecular level and thus their potential applications in medicine and industry (Cox et al 1998;Brasnu et al 2007). Leading these advances has been the development of a wide range of noninvasive, vital fluorescent probes in conjunction with faster imaging and quantification technologies including confocal laser scanning microscopy (CLSM) and fluorescent plate readers (Hansen et al 2000;Paddock 2008).…”