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Palak B. Wall, Thomas Mauger, Rebecca Kuennen, Andrew Hendershot; Confocal Interpretation compared with Clinical and Microbiological Findings in Atypical Keratitis : Review of 127 cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5860. doi: https://doi.org/.
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To evaluate the utility of confocal microscopy in the identification of fungal and acanthamoeba infections.
Confocal scans performed at OSU from 2002 through 2009 were read by three masked physicians and determined to be positive or negative. A retrospective case review of patients who had undergone confocal microscopy was performed. Patients were determined to be positive or negative for infection based on clinical impression, outcome, and culture, which was then compared to both the initial confocal readings and the masked physicians’ confocal readings.
Out of 344 studies and charts reviewed, the inclusion criteria were met by 126 confocal microscopy studies which had specifically been done to look for infectious keratitis and had sufficient follow up to determine the efficacy of treatment. The masked readers had a sensitivity of 76.4% and a specificity of 53.3% when compared to the previously determined overall clinical impression. The initial unmasked confocal readings had a sensitivity of 90.8% and a specificity of 87.1%. Cultures were positive in 27.3% of patients who were clinically determined to have fungal or acanthamoeba keratitis.
Atypical corneal infections are difficult to diagnose due to the low yield and slow growth on culture and frequent clinical misdiagnosis leading to a delay in treatment. Confocal microscopy is helpful in diagnosis of acanthamoeba and fungal keratitis, but it is most useful as an adjunct to clinical judgement and culture.
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