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V. S. Sangwan, P. K. Vaddavalli, A. M. Biyani; Role of Confocal Microscopy in Understanding the Response of Fungal Keratitis to Anti Fungal Therapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3715.
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To assess the response of fungal filaments and the host corneal tissue to antifungal therapy and to correlate the clinical course with in vivo confocal microscopy.
In this prospective non comparative observational case series, twenty five patients with microbiologically proven fungal keratitis were enrolled from June 2007 to November 2007. Ten subjects were excluded either due to loss of follow up, prescence of mixed infections or poor image qualityIn vivo confocal microscopy was performed in real time at various time points in the course of the disease to assess the changes in morphology of fungal filaments, density of inflammatory cells and appearance of keratocytes in microbiologically proven cases of fungal keratitis on antifungal therapy
The mean age of the subjects was 41.46 + 16.11 years (range 19-72 years). Eleven (73.33%) were males. The mean duration of symptoms prior to presentation was 7.13 + 4.79 days. Six subjects (40%) were on some form of treatment with anti-fungals. On microbiological examination, we identified unidentified dematiaceous fungi as the most common organism.On confocal microscopy, we observed a gradual reduction in the number of hyphae and in their density during the course of therapy A significant inverse relationship of inflammatory cells with fungal filaments was seen (p=<0.0032, ANOVA test). We also noted the presence of fungal filaments on confocal microscopy even after clinical resolution was achieved.
This study gives us an approximation of the in vivo response of fungal filaments and host corneal tissue to antifungal therapy. It also indicates that confocal microscopy can serve as a useful tool to monitor eradication of fungal filaments and aid in the decision of continuing or discontinuing antifungal therapy timely probably reducing the incidence of residual/ recurrent infection and of drug toxicity respectively
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