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J. A. Martinez Mendoza, R. Velasco, O. Baca, A. Babayan, W. Centellas; In vivo Confocal Microscopy in Infectious Corneal Ulcers. Invest. Ophthalmol. Vis. Sci. 2007;48(13):777.
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© ARVO (1962-2015); The Authors (2016-present)
To describe corneal ultrastructure of injured and adjacent tissue in ulcerative processes of diverse infectious etiology with in vivo confocal microscopy.
Prospective, transversal and observational study. Adult patients with corneal ulcers with clinical and cytological diagnosis were included between June and September 2006, clinical history or reference format was filled out. Panoramic photographs and confocal imaging in 3 modes (epi, endo and full) were taken. Scanning was performed at periphery and bed of the ulcers. Every case was recorded by mode and frames were classified by the corneal layer observed. Representative images were included in this study.
There were 12 eyes (12 patients), 6 male and 6 female, range from 21 to 67 years old (mean 49.25). 8,922 bidimensional frames (mean 247.83 per mode) were captured. Ulcerative keratitis cases were: 7 herpetic, 2 bacterial, 1 mixed (herpetic and bacterial), 1 secondary to Acantamoeba and 1 fungal. Findings were described as follows: herpetic keratitis showed giant multinucleated epithelial cells, hypereflective nucleous and intercellular space between basal membrane cells, pleomorphic activated keratocytes in whole stromal thickness even thought, all of them were superficial, corneal nervous bundles were observed until 2 month of follow up. Bacterial keratitis showed small and easily detachable epithelial cells; numerous, small and confluent keratocytes. Mixed and secondary to Acantamoeba ulcers showed similar stromal findings to those seen in bacterial infections. Fungal keratitis showed hypereflective septated phylliform images in anterior stroma (hyphae-like).
In vivo confocal microscopy allows the histological evaluation of the natural history of the disease and it’s possible to formulate differential diagnosis by etiology.
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