The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis

  • Seyed Ali Tabatabaei
  • Mohammad SoleimaniEmail author
  • Seyed Mehdi Tabatabaei
  • Amir Houshang Beheshtnejad
  • Niloufar Valipour
  • Shahram Mahmoudi
Original Paper



To evaluate the usefulness of serial in vivo confocal microscopy (IVCM) examinations to measure hyphal density for monitoring the treatment success among patients with fungal keratitis, and to compare the hyphal diameter as well as branching angle as a way of differentiation between Aspergillus and Fusarium species observed in IVCM.

Study design

Prospective nonrandomized study.

Patients and methods

The study was conducted from February 2015 to September 2016. Hyphal diameter, density and branching angle measurements were performed using IVCM at admission and on a weekly basis for at least 2 weeks after the start of treatment.


During the period of study, 65 patients with culture-confirmed fungal keratitis were recruited. Of them, 40 were culture-positive for Fusarium spp. and 25 patients for Aspergillus spp. Before the start of treatment, the mean branching angle did not differ between the two species and the mean hyphal diameter was statistically higher for Aspergillus spp. (p = 0.029). Two weeks after the start of treatment, the mean hyphal diameter was statistically lower (p < 0.001) in the treatment failure group. Also the hyphal density significantly decreased with successful treatment (p < 0.05).


Decreasing hyphal density in serial IVCMs might be used as an indicator to predict the successful response of fungal ulcers to treatment. Branching angle is not different between Aspergillus and Fusarium keratitis. The mean hyphal diameter is significantly lower in the treatment failure group.


Fungal keratitis Fusarium Aspergillus In vivo confocal microscopy Diagnosis Keratitis 



The authors should thank Mrs. Kasiri and Dr. Abedini because of their effort in obtaining confocal sequence imaging and microbiologic assessment, respectively.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Eye Research Center, Farabi Eye HospitalTehran University of Medical SciencesTehranIran
  2. 2.Department of Medical Parasitology and Mycology, School of Public HealthTehran University of Medical SciencesTehranIran
  3. 3.Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran

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