Abstract
Purpose :
To better understand the role of confocal microscopy in clinical decision making in the management of suspected microbial keratitis.
Methods :
A log of study requisitions was reviewed. The following items were recorded and analyzed: a. Date of confocal imaging, b. Source of request by setting of encounter (Emergency Department [ED], Cornea clinic, community doctor) c. Credential of requesting provider (ED resident, ED attending physician, Cornea Fellow, Cornea attending physician, community doctor), The date of any prior corneal culture(s) was queried from medical record in a pilot study of two seasonal subgroups of consecutive patients (9 winter and 9 summer).
Results :
59 requisitions were logged from Jan 1, 2019 to Nov 30, 2019. 22 (37%) were requested in relation to an Emergency Department encounter (1 by resident, 8 by ED attending, 3 by cornea fellow in conjunction with ED attending, and 10 by cornea fellow), 13 studies (22%) were requested by a cornea fellow in a follow-up clinic, 21 studies (36%) were requested by cornea attending in a scheduled visit, and 3 (5%) studies were requested by a community doctor.
Our pilot sample of winter requisitions showed 3/9 patients were from ED and that 7/9 had culture > 2 days prior, 2/9 had culture 1-2 days prior, and 4/9 had prior confocal imaging or final positive cultures. A sample of summer requisitions found that 5/9 were from the ED and that 1/9 had cultures > 2 days prior, 7/9 had cultures 1-2 days prior, 1/9 was never cultured, and 2/9 had prior confocal imaging or final positive cultures.
Conclusions :
Confocal microscopy in the management of suspected microbial keratitis is ordered by a variety of clinicians in a variety of settings at this tertiary care center. Credentials of the requesting physician vary with the season of the initial evaluation, as does the reason for imaging, with surveillance of treated cases being more common in the winter and workup of new infection more common in the summer. The pilot suggests that during summer imaging is requested with no or preliminary culture data. Further review and comparison of confocal and culture results is likely to provide insight into real time utility of this resource in a tertiary care setting.
This is a 2021 ARVO Annual Meeting abstract.