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E.T. Aliprandis, D. Miller, E. Alfonso; Confocal Microscopy in Fungal and Acanthamoebal Keratitis: Sensitivity and Utility in Guiding Treatment . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2613.
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Purpose: To evaluate the sensitivity of confocal microscopy in diagnosing fungal and acanthamoebal keratitis at the Bascom Palmer Eye Institute. Methods: In vivo confocal microscopy recordings of patients with positive fungal or acanthamoebal corneal cultures from January 2002 to November 2004 were reviewed for the presence of hyphal elements or acanthamoebal cysts. Sensitivity was determined by comparison of confocal findings to culture results. Results:Fungal hyphal elements were present in 50% (2 out of 4) patients with culture proven filamentous fungal keratitis who had confocal microscopy done. Acanthamoeba cysts were clearly identified on confocal microscopy in 50% (5 out of 10) of patients with culture proven acanthamoeba keratitis who had confocal microscopy done. Two of these patients had serial confocal examinations during treatment, and the number of cysts declined with each examination during the treatment course. Conclusions: Confocal microscopy may be helpful in the early diagnosis of fungal and acanthamoebal keratitis as well as in guiding length of treatment. Limitations to the technique include improper alignment with the specific area of corneal pathology, dense corneal opacification, and decreased sensitivity in early infections with lower microbial density.
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