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Diagnostic accuracy of confocal scan in detecting acanthamoeba keratitis and fungal keratitis: a systematic review and meta-analysis

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Abstract

Purpose

Acanthamoeba keratitis (AK) and fungal keratitis (FK) are two microbial keratitis that cause serious damage and, without early accurate diagnosis and treatment, may lead to blindness. In vivo corneal confocal scan, as an emerging ocular diagnostic method in comparison with microbiological smears and cultures as the gold standard, may assist in accelerating appropriate diagnosis.

Objective

To determine the diagnostic accuracy of confocal scan for the diagnosis of AK and FK.

Methods

Data were collected via a comprehensive literature search of PubMed, Web of Science, Cochrane Library, Embase and Scopus using keywords related to diagnostic accuracy of confocal scan in AK and FK up to October 2022. Pooled data underwent meta-analysis in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic odds ratio (DOR) of confocal scan for the diagnosis of AK and FK.

Results

The final 14 relevant studies were identified, including 1950 eyes. Meta-analysis in AK group revealed 94% sensitivity, 87% specificity, 89% PPV, 92% NPV, and DOR of 143.32, and in FK group disclosed 88% sensitivity, 85% specificity, 85% PPV, 88% NPV, and DOR of 75.98.

Conclusion

The accuracy of confocal scan for the diagnosis of AK was significantly more than that for detecting FK; despite the limitations such as limited numbers of available retrospective studies for the detection of FK, confocal scan had an acceptable performance in detecting FK eyes. The overall performance of NCS was similar with that of HRT-RCM for the detection of both types of keratitis.

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References

  1. Abbott RL, Zegans M, Elander TR (2004) Acanthamoeba keratitis. In: Tasman W (ed) Foundations of Duane’s clinical ophthalmology. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Arffa RC, Grayson M (1991) Grayson's diseases of the cornea. In: St. Louis, MO (3th ed) Mosby-YearBook. http://books.google.com/books?id=CJ5sAAAAMAAJ

  3. Sharma S, Kunimoto DY, Gopinathan U et al (2002) Evaluation of corneal scraping smear examination methods in the diagnosis of bacterial and fungal keratitis: a survey of eight years of laboratory experience. Cornea 21(7):643–647

    Article  PubMed  Google Scholar 

  4. Ficker L, Kirkness C, McCartney A et al (1991) Microbial keratitis—;the false negative. Eye 5(5):549–559

    Article  PubMed  Google Scholar 

  5. Ferrer C, Alió JL (2011) Evaluation of molecular diagnosis in fungal keratitis. Ten years of experience. J Ophthalmic Inflamm Infect 1(1):15–22

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Radford CF, Minassian DC, Dart JKG (2002) Acanthamoeba keratitis in England and Wales: incidence, outcome, and risk factors. Br J Ophthalmol 86(5):536–542

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Page MA, Mathers WD (2013) Acanthamoeba keratitis: a 12-Year experience covering a wide spectrum of presentations, diagnoses, and outcomes. J Ophthalmol 2013:670242

    Article  PubMed  PubMed Central  Google Scholar 

  8. Thebpatiphat N, Hammersmith KM, Rocha FN et al (2007) Acanthamoeba keratitis: a parasite on the rise. Cornea 26(6):701–706

    Article  PubMed  Google Scholar 

  9. Thomas PA, Geraldine P (2007) Infectious keratitis. Curr Opin Infect Dis 20(2):129–41

    Article  PubMed  Google Scholar 

  10. Thomas PA, Leck AK, Myatt M (2005) Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi. Br J Ophthalmol 89(12):1554–1558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. O’Day DM, Head WS (2000) Advances in the management of keratomycosis and Acanthamoeba keratitis. Cornea 19(5):681–687

    Article  PubMed  Google Scholar 

  12. Illingworth CD, Cook SD (1998) Acanthamoeba keratitis. Surv Ophthalmol 42(6):493–508

    Article  CAS  PubMed  Google Scholar 

  13. Jalbert I, Stapleton F, Papas E et al (2003) In vivo confocal microscopy of the human cornea. Br J Ophthalmol 87(2):225–236

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Niederer RL, McGhee CNJ (2010) Clinical in vivo confocal microscopy of the human cornea in health and disease. Prog Retin Eye Res 29(1):30–58

    Article  CAS  PubMed  Google Scholar 

  15. McInnes MDF, Moher D, Thombs BD et al (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319:388–396

    Article  PubMed  Google Scholar 

  16. Whiting P, Rutjes AWS, Reitsma JB et al (2004) Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 140(3):189–202

    Article  PubMed  Google Scholar 

  17. Rutter CM, Gatsonis CA (2001) A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20(19):2865–2884

  18. Chidambaram JD, Prajna NV, Larke NL et al (2016) Prospective study of the diagnostic accuracy of the in vivo laser scanning confocal microscope for severe microbial keratitis. Ophthalmology 123(11):2285–2293

    Article  PubMed  Google Scholar 

  19. Goh JWY, Harrison R, Hau S et al (2018) Comparison of in vivo confocal microscopy, PCR and culture of corneal scrapes in the diagnosis of acanthamoeba keratitis. Cornea 37(4):480–485

    Article  PubMed  Google Scholar 

  20. Kanavi MR, Javadi M, Yazdani S et al (2007) Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis. Cornea 26(7):782–786

    Article  PubMed  Google Scholar 

  21. Kheirkhah A, Syed ZA, Satitpitakul V et al (2017) Sensitivity and specificity of laser-scanning in vivo confocal microscopy for filamentous fungal keratitis: role of observer experience. Am J Ophthalmol 179:81–89

    Article  PubMed  Google Scholar 

  22. Kheirkhah A, Satitpitakul V, Syed ZA et al (2018) Factors influencing the diagnostic accuracy of laser-scanning in vivo confocal microscopy for Acanthamoeba keratitis. Cornea 37(7):818–823

    Article  PubMed  Google Scholar 

  23. McKelvie J, Alshiakhi M, Ziaei M et al (2018) The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation, diagnosis and outcomes (2009–2016). Clin Exp Ophthalmol 46(6):600–607

    Article  PubMed  Google Scholar 

  24. Tu EY, Joslin CE, Sugar J et al (2008) The relative value of confocal microscopy and superficial corneal scrapings in the diagnosis of acanthamoeba keratitis. Cornea 27(7):764–772

    Article  PubMed  Google Scholar 

  25. Vaddavalli PK, Garg P, Sharma S et al (2011) Role of confocal microscopy in the diagnosis of fungal and acanthamoeba keratitis. Ophthalmology 118(1):29–35

    Article  PubMed  Google Scholar 

  26. Füst Á, Tóth J, Simon G, Imre L, Nagy ZZ (2017) Specificity of in vivo confocal cornea microscopy in Acanthamoeba keratitis. Eur J Ophthalmol 27(1):10–15

    Article  PubMed  Google Scholar 

  27. De Craene S, Knoeri J, Georgeon C, Kestelyn P, Borderie VM (2018) Assessment of confocal microscopy for the diagnosis of polymerase chain reaction-positive Acanthamoeba Keratitis: a case-control study. Ophthalmology 125(2):161–168

    Article  PubMed  Google Scholar 

  28. Hau SC, Dart JK, Vesaluoma M et al (2010) Diagnostic accuracy of microbial keratitis with in vivo scanning laser confocal microscopy. Br J Ophthalmol 94(8):982–987

    Article  PubMed  Google Scholar 

  29. Nasef MH, El Emam SY, ElShorbagy MS, Allam WA. Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes. Clin Ophthalmol. 2021;15:1339–1347. Published 2021 Mar 29

  30. Parmar DN, Awwad ST, Petroll WM, Bowman RW, McCulley JP, Cavanagh HD (2006) Tandem scanning confocal corneal microscopy in the diagnosis of suspected acanthamoeba keratitis. Ophthalmology 113(4):538–547

    Article  PubMed  Google Scholar 

  31. Mathers WD, Nelson SE, Lane JL, Wilson ME, Allen RC, Folberg R (2000) Confirmation of confocal microscopy diagnosis of Acanthamoeba keratitis using polymerase chain reaction analysis. Arch Ophthalmol 118(2):178–183

    Article  CAS  PubMed  Google Scholar 

  32. Vengayil S, Panda A, Satpathy G et al (2009) Polymerase chain reaction-guided diagnosis of mycotic keratitis: a prospective evaluation of its efficacy and limitations. Investig Ophthalmol Vis Sci 50(1):152–156

    Article  Google Scholar 

  33. Yera H, Ok V, Lee K et al (2021) PCR and culture for diagnosis of Acanthamoeba keratitis. Br J Ophthalmol 105(9):1302–1306

    Article  PubMed  Google Scholar 

  34. Zhang Y, Wang ZQ, Deng SJ et al (2019) Diagnostic value of fungal fluorescence staining on corneal scrapings for fungal keratitis. Zhonghua Yan Ke Za Zhi 55(8):601–608

    CAS  PubMed  Google Scholar 

  35. Dahlgren MA, Lingappan A, Wilhelmus KR (2007) The Clinical diagnosis of microbial keratitis. Am J Ophthalmol 143(6):940–944

    Article  PubMed  PubMed Central  Google Scholar 

  36. Abolhosseini M, Moshtaghion SM, Kanavi R, Hosseini SB (2021) A triad of microscopes for rapid and proper diagnosis of infectious keratitis. Clin Exp Optom 16:1–3

    Google Scholar 

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Seyed Mohamadmehdi Moshtaghion and Mohammad Abolhosseini have equal contribution to this work.

Authors and Affiliations

  1. Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard St., Boostan 9 St., Pasdaran Ave., Tehran, 1666673111, Iran

    Seyed Mohamadmehdi Moshtaghion, Mohammad Abolhosseini & Mozhgan Rezaei Kanavi

  2. Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran

    Mehdi Yaseri

  3. Department of Confocal Scan, Central Eye Bank of Iran, Tehran, Iran

    Mohammad Abolhosseini & Seyed Bagher Hosseini

  4. Department of Regeneration and Cell Therapy, Andalusian Molecular Biology and Regenerative Medicine Centre (CABIMER), Avda. Américo Vespucio 24, 41092, Seville, Spain

    Seyed Mohamadmehdi Moshtaghion

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Contributions

The authors listed below have made substantial contributions to the intellectual content of the paper in the various sections described below. (a) Conception and design: MRK, MA and SMM. (b) Acquisition of data: MRK, MA, SMM and SBH. (c) Analysis and interpretation of data: MY, SMM and MA. (d) Drafting of the manuscript: All authors. (e) Statistical analysis: MY. All the authors read and approved the final manuscript.

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Correspondence to Mozhgan Rezaei Kanavi.

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Moshtaghion, S.M., Abolhosseini, M., Yaseri, M. et al. Diagnostic accuracy of confocal scan in detecting acanthamoeba keratitis and fungal keratitis: a systematic review and meta-analysis. Int Ophthalmol 43, 3011–3022 (2023). https://doi.org/10.1007/s10792-023-02689-z

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