In vivo confocal microscopy cellular features of host and organism in bacterial, fungal and Acanthamoeba keratitis.

Chidambaram, JD; Prajna, NV; Palepu, S; Lanjewar, S; Shah, M; Elakkiya, S; Macleod, D; Lalitha, P; Burton, MJ; (2018) In vivo confocal microscopy cellular features of host and organism in bacterial, fungal and Acanthamoeba keratitis. American journal of ophthalmology. ISSN 0002-9394 DOI:

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To determine cellular features of fungal (FK), Acanthamoeba (AK) and bacterial keratitis (BK) using HRT3 in vivo confocal microscopy (IVCM). Prospective observational cross-sectional study. Eligible participants were adults with microbiologically-positive FK, AK or BK, of size ≥3mm attending Aravind Eye Hospital from Feb 2012 to Feb 2013. descemetocele, perforation. At presentation, IVCM imaging was performed, then corneal scrapes obtained for culture/light microscopy. An experienced grader (masked to microbiology/clinical features) assessed IVCM images for presence/absence of normal keratocyte-like morphology, stellate interconnected cells with/without visible nuclei, dendritiform cells (DFCs), inflammatory cells in a honeycomb distribution, and organism features. Statistical significance assessed by logistic regression, adjusted for age, sex, ulcer size, symptom duration. Presence/absence of IVCM features in FK, AK, BK. 183 participants had FK, 18 AK, 17 BK. Acanthamoeba appeared as bright spots (n=16/18, 89%), double-walled cysts (n=15/18, 83%) or signet rings (n=3/18, 17%), and often formed clusters after topical steroid use (univariable OR 9.98, 95% CI 1.02-97.96, p=0.048). BK was associated with bullae in anterior stroma (OR 9.99, 95% CI: 3.11-32.06, p<0.001). Honeycomb distribution of anterior stromal inflammatory cells was associated with FK (univariable OR 2.74, 95%CI: 1.01-7.40, p=0.047). Aspergillus ulcers were associated with stromal DFCs (OR 11.05, 95% CI: 1.49-82.13, p=0.019) and Fusarium ulcers with stellate appearance of interconnected cell processes with nuclei (OR 0.24, 95% CI: 0.09-0.65, p=0.005). Specific cellular and structural features observed using IVCM in microbial keratitis may be associated with organism.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: International Centre for Eye Health
PubMed ID: 29550185


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