Abstract
Background
To evaluate antifungal chemotherapy in patients with fungal keratitis guided by in vivo confocal microscopy.
Methods
A total of 121 patients (121 eyes) with fungal keratitis were enrolled in this study. Confocal microscopy was performed in real time after topical and/or oral antifungal chemotherapy. Hyphal density and morphology, composition of inflammatory cells, and appearance of corneal stromal cells at the central and peripheral corneal lesions were recorded. Antifungal therapy discontinued at 1 week after hyphae and inflammatory cells could not be detected, and affected corneal stromal cells became visible.
Results
Successful outcomes were achieved in 110 patients (90.9%). By confocal microscopy, we observed the gradual decrease of hyphae-positive sites and hyphal density during the chemotherapy. The inflammatory cells reduced in number and heterogeneity, while corneal stromal cells recovered. The antifungal drugs were tapered according to the changes in hyphae, inflammatory cells, and corneal stromal cells. There was no fungal recurrence during the 2-month follow-up period. The other 11 patients (9.1%) had deteriorated infection within 1 week of antifungal therapy, and therefore were subjected to corneal transplantation.
Conclusions
In vivo confocal microscopy appears to be an effective approach to guide antifungal chemotherapy. It allows comprehensive evaluation of hyphae, inflammatory cells, and corneal stromal cells in real time, and provides valuable and objective information required in selecting and adjusting therapeutic regimens for the treatment of fungal keratitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, Wilkins J, Smolin G, Whitcher JP (1997) Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 81:965–971
Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, Newman MJ, Codjoe FS, Opintan JA, Kalavathy CM, Essuman V, Jesudasan CA, Johnson GJ (2002) Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 86:1211–1215
Xie L, Dong X, Shi W (2001) Treatment of fungal keratitis by penetrating keratoplasty. Br J Ophthalmol 85:1070–1074
Dursun D, Fernandez V, Miller D, Alfonso EC (2003) Advanced fusarium keratitis progressing to endophthalmitis. Cornea 22:300–303
Xie L, Zhong W, Shi W, Sun S (2006) Spectrum of fungal keratitis in north China. Ophthalmology 113:1943–1948
Srinivasan M (2004) Fungal keratitis. Curr Opin Ophthalmol 15:321–327
Ganegoda N, Rao SK (2004) Antifungal therapy for keratomycoses. Expert Opin Pharmacother 5:865–874
Kalavathy CM, Parmar P, Kaliamurthy J, Philip VR, Ramalingam MD, Jesudasan CA, Thomas PA (2005) Comparison of topical itraconazole 1% with topical natamycin 5% for the treatment of filamentous fungal keratitis. Cornea 24:449–452
Thomas PA (2003) Fungal infections of the cornea. Eye 17:852–862
Thomas PA (2003) Current perspectives on ophthalmic mycoses. Clin Microbiol Rev 16:730–797
Chiou AG, Kaufman SC, Kaufman HE, Beuerman RW (2006) Clinical corneal confocal microscopy. Surv Ophthalmol 51:482–500
Florakis GJ, Moazami G, Schubert H, Koester CJ, Auran JD (1997) Scanning slit confocal microscopy of fungal keratitis. Arch Ophthalmol 115:1461–1463
Kaufman SC, Musch DC, Belin MW, Cohen EJ, Meisler DM, Reinhart WJ, Udell IJ, Van Meter WS (2004) Confocal microscopy: a report by the American Academy of Ophthalmology. Ophthalmology 111:396–406
Brasnu E, Bourcier T, Dupas B, Degorge S, Rodallec T, Laroche L, Borderie V, Baudouin C (2007) In vivo confocal microscopy in fungal keratitis. Br J Ophthalmol 91:588–591
Khanal B, Deb M, Panda A, Sethi HS (2005) Laboratory diagnosis in ulcerative keratitis. Ophthalmic Res 37:123–127
Cheng LL, Young AL, Wong AK, Law RW, Lam DS (2004) In vivo confocal microscopy of Thygeson’s superficial punctate keratitis. Clin Experiment Ophthalmol 32:325–327
Jalbert I, Stapleton F, Papas E, Sweeney DF, Coroneo M (2003) In vivo confocal microscopy of the human cornea. Br J Ophthalmol 87:225–236
Vaddavalli PK, Garg P, Sharma S, Thomas R, Rao GN (2006) Confocal microscopy for Nocardia keratitis. Ophthalmology 113:1645–1650
Avunduk AM, Beuerman RW, Varnell ED, Kaufman HE (2003) Confocal microscopy of Aspergillus fumigatus keratitis. Br J Ophthalmol 87:409–410
Fons A, Garcia-de-Lomas J, Nogueira JM, Buesa FJ, Gimeno C (1988) Histopathology of experimental Aspergillus fumigatus keratitis. Mycopathologia 101:129–131
Moilanen JA, Vesaluoma MH, Muller LJ, Tervo TM (2003) Long-term corneal morphology after PRK by in vivo confocal microscopy. Invest Ophthalmol Vis Sci 44:1064–1069
Patel S, McLaren J, Hodge D, Bourne W (2001) Normal human keratocyte density and corneal thickness measurement by using confocal microscopy in vivo. Invest Ophthalmol Vis Sci 42:333–339
Acknowledgements
This study was supported in part by the National Natural Science Foundation of China (30630063, 30271394), Department of Science and Technology of Shandong Province (2004GG2202154), and Qingdao Municipal Science and Technology Bureau (02KGYSH-01). The authors thank Ms. Ping Lin for her editorial assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shi, W., Li, S., Liu, M. et al. Antifungal chemotherapy for fungal keratitis guided by in vivo confocal microscopy. Graefes Arch Clin Exp Ophthalmol 246, 581–586 (2008). https://doi.org/10.1007/s00417-007-0719-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-007-0719-x