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Effectiveness of In Vivo Confocal Microscopy in Detecting Filamentous Fungi During Clinical Course of Fungal Keratitis

Takezawa, Yuki MD; Shiraishi, Atsushi MD, PhD; Noda, Eriko MD; Hara, Yuko MD; Yamaguchi, Masahiko MD, PhD; Uno, Toshihiko MD, PhD; Ohashi, Yuichi MD, PhD

doi: 10.1097/ICO.0b013e3181cd3c84
Clinical Science

Purpose: To determine the effectiveness of laser confocal microscopy in detecting filamentous fungi in the cornea of patients with fungal keratitis (FK) and in evaluating the effectiveness of the treatment.

Methods: The corneas of 6 patients clinically diagnosed with FK were examined with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Three of these patients were also monitored periodically with the HRT II-RCM after antifungal treatment.

Results: The HRT II-RCM examination showed interlocking and branching, white, septated, hyphae-like lines in the cornea of all patients. All 6 patients had positive corneal smears and/or laboratory cultures. Three patients were monitored with HRT II-RCM after antifungal treatment. One patient, whose initial smear was negative, was diagnosed by HRT II-RCM before the positive culture results. In another case, the epithelial regeneration was impaired even 3 weeks after the initial treatment and HRT II-RCM revealed a mass of hyphae in the corneal ulcerated lesion. These findings indicated the necessity of surgical debridement. After the surgical debridement, the corneal epithelial defect was healed. HRT II-RCM was able to detect the morphological changes of hyphae after antifungal treatment and helped in the treatment modifications during the clinical course in all 3 patients.

Conclusions: These results indicate that HRT II-RCM can be used to diagnose FK and to monitor the effect of therapy on FK.

From the *Departments of Ophthalmology; †Ophthalmology and Regenerative Medicine; ‡Cell Growth and Tumor Regulation; and §Infectious Diseases, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.

Received for publication October 6, 2009; revision received November 19, 2009, 2009; accepted November 26, 2009.

Financial support: None.

Reprints: Atsushi Shiraishi, Department of Ophthalmology and Regenerative Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan (e-mail:

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