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Kryszan K, Wylęgała A, Kijonka M, Potrawa P, Walasz M, Wylęgała E, Orzechowska-Wylęgała B. Artificial-Intelligence-Enhanced Analysis of In Vivo Confocal Microscopy in Corneal Diseases: A Review. Diagnostics (Basel) 2024; 14:694. [PMID: 38611606 PMCID: PMC11011861 DOI: 10.3390/diagnostics14070694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Artificial intelligence (AI) has seen significant progress in medical diagnostics, particularly in image and video analysis. This review focuses on the application of AI in analyzing in vivo confocal microscopy (IVCM) images for corneal diseases. The cornea, as an exposed and delicate part of the body, necessitates the precise diagnoses of various conditions. Convolutional neural networks (CNNs), a key component of deep learning, are a powerful tool for image data analysis. This review highlights AI applications in diagnosing keratitis, dry eye disease, and diabetic corneal neuropathy. It discusses the potential of AI in detecting infectious agents, analyzing corneal nerve morphology, and identifying the subtle changes in nerve fiber characteristics in diabetic corneal neuropathy. However, challenges still remain, including limited datasets, overfitting, low-quality images, and unrepresentative training datasets. This review explores augmentation techniques and the importance of feature engineering to address these challenges. Despite the progress made, challenges are still present, such as the "black-box" nature of AI models and the need for explainable AI (XAI). Expanding datasets, fostering collaborative efforts, and developing user-friendly AI tools are crucial for enhancing the acceptance and integration of AI into clinical practice.
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Affiliation(s)
- Katarzyna Kryszan
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland; (A.W.); (M.K.); (E.W.)
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; (P.P.); (M.W.)
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland; (A.W.); (M.K.); (E.W.)
- Health Promotion and Obesity Management, Pathophysiology Department, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Magdalena Kijonka
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland; (A.W.); (M.K.); (E.W.)
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; (P.P.); (M.W.)
| | - Patrycja Potrawa
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; (P.P.); (M.W.)
| | - Mateusz Walasz
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; (P.P.); (M.W.)
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland; (A.W.); (M.K.); (E.W.)
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; (P.P.); (M.W.)
| | - Bogusława Orzechowska-Wylęgała
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Chair of Pediatric Surgery, Medical University of Silesia, 40-760 Katowice, Poland;
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Alreshidi SO, Vargas JM, Ahmad K, Alothman AY, Albalawi ED, Almulhim A, Alenezi SH, ALBalawi HB, Alali NM, Hashem F, Aljindan M. Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features. PLoS One 2024; 19:e0299492. [PMID: 38470877 DOI: 10.1371/journal.pone.0299492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Infectious Keratitis is one of the most common ocular emergencies seen by ophthalmologists. Our aim is to identify the risk factors and clinical features of Acanthamoeba Keratitis (AK). METHODS This retrospective chart review study was conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and included all the microbial keratitis cases, male and female patients of all ages. The main outcome is the differentiation between various microbial keratitis types. RESULTS We included 134 consecutive eyes of 126 persons. We had 24 cases of acanthamoeba keratitis, 22 bacterial keratitis, 24 fungal keratitis, 32 herpetic keratitis, and 32 bacterial co-infection. Contact lens wear was found in 33 eyes (24.6%). Among acanthamoeba keratitis patients, 73% were ≤ 39 years of age, and 73% were females (P <0.001). Also, in AK cases, epithelial defect was found in all cases (100%), endothelial plaques were found in 18 eyes (69.2%), 12 cases had radial keratoneuritis (46.2%), and ring infiltrate was found in 53.8% of AK cases. CONCLUSIONS We determined the factors that increase the risk of acanthamoeba infection and the clinical characteristics that help distinguish it from other types of microbial keratitis. Our findings suggest that younger females and patients who wear contact lenses are more likely to develop acanthamoeba keratitis. The occurrence of epitheliopathy, ring infiltrate, radial keratoneuritis, and endothelial plaques indicate the possibility of acanthamoeba infection. Promoting education on wearing contact lenses is essential to reduce the risk of acanthamoeba infection, as it is the most significant risk factor for this infection.
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Affiliation(s)
| | - José Manuel Vargas
- Cornea, External Diseases Section, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Ophthalmology Division, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmed Yousef Alothman
- Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eman D Albalawi
- Clinical Sciences Department, College of Medicine, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Saudi Arabia
| | - Saad Hamdan Alenezi
- Ophthalmology Department, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Hani Basher ALBalawi
- Department of Surgery, Division of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Naif Mamdouh Alali
- Department of Surgery, Division of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Faris Hashem
- Department of Surgery, Division of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Mohanna Aljindan
- Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Kim CK, Mekhail JT, Morcos DM, Yang CD, Kedhar SR, Kim C, Del Valle Estopinal M, Lee OL. Three cases of recalcitrant Paecilomyces keratitis in Southern California within a short period. J Ophthalmic Inflamm Infect 2024; 14:1. [PMID: 38175332 PMCID: PMC10766921 DOI: 10.1186/s12348-023-00380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The aim of this report is to describe the risk factors, clinical course, and characteristics of three cases of Paecilomyces keratitis presenting concurrently within three months in the same location. We used in vivo confocal microscopy and histopathology to corroborate our clinical findings. OBSERVATIONS Three eyes of three elderly patients with culture-proven Paecilomyces keratitis were included in this series. These patients resided within a 15-mile radius and presented to a tertiary care eye institute in Southern California between February and April 2022. All three eyes experienced a prolonged, recalcitrant course with recurrence of keratitis in donor corneal tissue despite antifungal therapy and multiple therapeutic penetrating keratoplasties. In vivo confocal microscopy, histopathology, and microbiologic findings corroborated the diagnosis of fungal keratitis with Paecilomyces. With surgical intervention and extensive medical therapy, all three cases resolved after the addition of oral Posaconazole. CONCLUSIONS Paecilomyces is a rare cause of infectious keratitis. Herein we report three similar cases in elderly patients. All had prolonged, recalcitrant infections that required multiple treatment modalities. Our cases, which were supported by in vivo confocal microscopy and histopathology, highlight the importance of timely and aggressive therapy to prevent recurrence.
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Affiliation(s)
- Christine K Kim
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA.
| | - Joseph T Mekhail
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
| | - David M Morcos
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Christopher D Yang
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Sanjay R Kedhar
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Cinthia Kim
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Maria Del Valle Estopinal
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
- Department of Pathology, University of California Irvine, Irvine, CA, USA
| | - Olivia L Lee
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA
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Curro-Tafili K, Verbraak FD, de Vries R, van Nispen RMA, Ghyczy EAE. Diagnosing and monitoring the characteristics of Acanthamoeba keratitis using slit scanning and laser scanning in vivo confocal microscopy. Ophthalmic Physiol Opt 2024; 44:131-152. [PMID: 37916883 DOI: 10.1111/opo.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/09/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Acanthamoeba keratitis (AK) is a serious and potentially blinding ocular infection caused by the free-living amoeba, Acanthamoeba. In vivo confocal microscopy (IVCM) is a non-invasive device which has been proven of great use to diagnose Acanthamoeba infections immediately. The aim of this review was to establish different patterns and signs of AK that appear on the IVCM both before and after treatment. METHODS A systematic review of the literature from 1974 until September 2021 was performed using Embase and PubMed, following The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty different signs of AK were observed using IVCM. The included studies used vastly different criteria to diagnose infections, ranging from just 1 to 13 of the signs, demonstrating the current lack of a standardised diagnosis of this infection using the IVCM. The appearance of double wall cysts, trophozoites, signet rings, target signs and clusters were shown to be pathognomonic to AK infections. Bright spots located in the corneal epithelium were demonstrated as non-reliable predictors of AK. The presence of cysts in clusters and single file can predict the need for corneal transplantation. The morphological changes in cysts using the IVCM following treatment were described as breaking down to hollow forms and occasionally surrounded by black cavities. Using this information, a visual guideline for identifying AK signs in diagnosis and follow-up using IVCM was created. CONCLUSION Increased awareness of the different signs and patterns of AK that appear on the IVCM is crucial in order to correctly identify an infection and increase the potential of this device. Our guidelines presented here can be used, but further studies are needed in order to determine the relationship and aetiology of these signs and cellular changes on the IVCM both before and after anti-amoeba treatment.
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Affiliation(s)
- K Curro-Tafili
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - F D Verbraak
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - R M A van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - E A E Ghyczy
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Shareef O, Shareef S, Saeed HN. New Frontiers in Acanthamoeba Keratitis Diagnosis and Management. BIOLOGY 2023; 12:1489. [PMID: 38132315 PMCID: PMC10740828 DOI: 10.3390/biology12121489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Acanthamoeba Keratitis (AK) is a severe corneal infection caused by the Acanthamoeba species of protozoa, potentially leading to permanent vision loss. AK requires prompt diagnosis and treatment to mitigate vision impairment. Diagnosing AK is challenging due to overlapping symptoms with other corneal infections, and treatment is made complicated by the organism's dual forms and increasing virulence, and delayed diagnosis. In this review, new approaches in AK diagnostics and treatment within the last 5 years are discussed. The English-language literature on PubMed was reviewed using the search terms "Acanthamoeba keratitis" and "diagnosis" or "treatment" and focused on studies published between 2018 and 2023. Two hundred sixty-five publications were initially identified, of which eighty-seven met inclusion and exclusion criteria. This review highlights the findings of these studies. Notably, advances in PCR-based diagnostics may be clinically implemented in the near future, while antibody-based and machine-learning approaches hold promise for the future. Single-drug topical therapy (0.08% PHMB) may improve drug access and efficacy, while oral medication (i.e., miltefosine) may offer a treatment option for patients with recalcitrant disease.
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Affiliation(s)
- Omar Shareef
- School of Engineering and Applied Sciences, Harvard College, Cambridge, MA 02138, USA;
| | - Sana Shareef
- Department of Bioethics, Columbia University, New York, NY 10027, USA
| | - Hajirah N. Saeed
- Department of Ophthalmology, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
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Cabrera-Aguas M, Watson SL. Updates in Diagnostic Imaging for Infectious Keratitis: A Review. Diagnostics (Basel) 2023; 13:3358. [PMID: 37958254 PMCID: PMC10647798 DOI: 10.3390/diagnostics13213358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Infectious keratitis (IK) is among the top five leading causes of blindness globally. Early diagnosis is needed to guide appropriate therapy to avoid complications such as vision impairment and blindness. Slit lamp microscopy and culture of corneal scrapes are key to diagnosing IK. Slit lamp photography was transformed when digital cameras and smartphones were invented. The digital camera or smartphone camera sensor's resolution, the resolution of the slit lamp and the focal length of the smartphone camera system are key to a high-quality slit lamp image. Alternative diagnostic tools include imaging, such as optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). OCT's advantage is its ability to accurately determine the depth and extent of the corneal ulceration, infiltrates and haze, therefore characterizing the severity and progression of the infection. However, OCT is not a preferred choice in the diagnostic tool package for infectious keratitis. Rather, IVCM is a great aid in the diagnosis of fungal and Acanthamoeba keratitis with overall sensitivities of 66-74% and 80-100% and specificity of 78-100% and 84-100%, respectively. Recently, deep learning (DL) models have been shown to be promising aids for the diagnosis of IK via image recognition. Most of the studies that have developed DL models to diagnose the different types of IK have utilised slit lamp photographs. Some studies have used extremely efficient single convolutional neural network algorithms to train their models, and others used ensemble approaches with variable results. Limitations of DL models include the need for large image datasets to train the models, the difficulty in finding special features of the different types of IK, the imbalance of training models, the lack of image protocols and misclassification bias, which need to be overcome to apply these models into real-world settings. Newer artificial intelligence technology that generates synthetic data, such as generative adversarial networks, may assist in overcoming some of these limitations of CNN models.
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Affiliation(s)
- Maria Cabrera-Aguas
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia;
- Sydney Eye Hospital, Sydney, NSW 2000, Australia
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Azzopardi M, Chong YJ, Ng B, Recchioni A, Logeswaran A, Ting DSJ. Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics (Basel) 2023; 13:2655. [PMID: 37627913 PMCID: PMC10453105 DOI: 10.3390/diagnostics13162655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.
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Affiliation(s)
- Matthew Azzopardi
- Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK;
| | - Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Chiang JCB, Roy M, Kim J, Markoulli M, Krishnan AV. In-vivo corneal confocal microscopy: Imaging analysis, biological insights and future directions. Commun Biol 2023; 6:652. [PMID: 37336941 DOI: 10.1038/s42003-023-05005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
In-vivo corneal confocal microscopy is a powerful imaging technique which provides clinicians and researcher with the capabilities to observe microstructures at the ocular surfaces in significant detail. In this Mini Review, the optics and image analysis methods with the use of corneal confocal microscopy are discussed. While novel insights of neuroanatomy and biology of the eyes, particularly the ocular surface, have been provided by corneal confocal microscopy, some debatable elements observed using this technique remain and these are explored in this Mini Review. Potential improvements in imaging methodology and instrumentation are also suggested.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, NSW, UK
| | - Maitreyee Roy
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Juno Kim
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Arun V Krishnan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Department of Neurology, Prince of Wales Hospital, Sydney, NSW, Australia.
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Abbondante S, Leal SM, Clark HL, Ratitong B, Sun Y, Ma LJ, Pearlman E. Immunity to pathogenic fungi in the eye. Semin Immunol 2023; 67:101753. [PMID: 37060806 PMCID: PMC10508057 DOI: 10.1016/j.smim.2023.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Indexed: 04/17/2023]
Abstract
Fusarium, Aspergillus and Candida are important fungal pathogens that cause visual impairment and blindness in the USA and worldwide. This review will summarize the epidemiology and clinical features of corneal infections and discuss the immune and inflammatory responses that play an important role in clinical disease. In addition, we describe fungal virulence factors that are required for survival in infected corneas, and the activities of neutrophils in fungal killing, tissue damage and cytokine production.
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Affiliation(s)
- Serena Abbondante
- Department of Ophthalmology, and Department of Physiology and Biophysics, University of California, Irvine, CA, USA
| | - Sixto M Leal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Bridget Ratitong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yan Sun
- Department of Ophthalmic Research, Cole Eye Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Li-Jun Ma
- Department of Biochemistry and Molecular Biology, University of Massachusetts, Amherst, MA, USA
| | - Eric Pearlman
- Department of Ophthalmology, and Department of Physiology and Biophysics, University of California, Irvine, CA, USA.
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Sitnova A, Svetozarskiy S. Modern Technologies in Diagnosis of Fungal Keratitis (Review). Sovrem Tekhnologii Med 2023; 15:73-84. [PMID: 37389020 PMCID: PMC10306968 DOI: 10.17691/stm2023.15.2.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Indexed: 07/01/2023] Open
Abstract
Traumas and infectious diseases of the eye play a leading role in the development of corneal blindness responsible for 1.5-2 million cases of vision loss per year. To date, the issue of reducing the incidence of fungal keratitis is acute and needs to be solved worldwide. Trauma as a risk factor for corneal fungal disease is thought to be prevalent in developing countries due to agricultural involvement, while in developed countries the onset of the disease is predisposed by medical advances such as contact vision correction and modern ophthalmic surgery. Thorough analysis of the pathogenesis gives the possibility to describe the action of fungal enzymes, biofilm formation, and the resistance mechanism, which on the one hand explains the aggressive course of the disease and difficulties in its diagnosis, and on the other hand, it encourages searching for new methods of diagnosis and treatment. The non-specific clinical picture of fungal keratitis, the variety and availability of antibiotics nowadays become an obstacle for rapid detection of this pathology. Low public awareness and late visit to an ophthalmologist are also a barrier to successful combating the increasing incidence of fungal keratitis. Belated diagnosis, increasing resistance of fungi to antibiotics, and lack of registered antifungal ophthalmic drugs justify poor treatment efficacy resulting in decreased visual acuity or vision loss. Existing diagnostic methods need systematization and detailed comparison, identifying the advantages and disadvantages of each. This review considers causative agents and their influence on pathogenesis of the disease, describes difficulties of fungal keratitis diagnosis and possible ways of overcoming these problems using new developments, and also outlines further prospects of research in this direction.
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Affiliation(s)
- A.V. Sitnova
- 6-year Student, Medical Faculty; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S.N. Svetozarskiy
- Ophthalmologist; Privolzhsky District Medical Center of the Federal Medico-Biological Agency (FMBA), 14 Ilyinskaya St., Nizhny Novgorod, 603000, Russia Tutor, Department of Eye Diseases; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Automatic Diagnosis of Infectious Keratitis Based on Slit Lamp Images Analysis. J Pers Med 2023; 13:jpm13030519. [PMID: 36983701 PMCID: PMC10056612 DOI: 10.3390/jpm13030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Infectious keratitis (IK) is a common ophthalmic emergency that requires prompt and accurate treatment. This study aimed to propose a deep learning (DL) system based on slit lamp images to automatically screen and diagnose infectious keratitis. This study established a dataset of 2757 slit lamp images from 744 patients, including normal cornea, viral keratitis (VK), fungal keratitis (FK), and bacterial keratitis (BK). Six different DL algorithms were developed and evaluated for the classification of infectious keratitis. Among all the models, the EffecientNetV2-M showed the best classification ability, with an accuracy of 0.735, a recall of 0.680, and a specificity of 0.904, which was also superior to two ophthalmologists. The area under the receiver operating characteristics curve (AUC) of the EffecientNetV2-M was 0.85; correspondingly, 1.00 for normal cornea, 0.87 for VK, 0.87 for FK, and 0.64 for BK. The findings suggested that the proposed DL system could perform well in the classification of normal corneas and different types of infectious keratitis, based on slit lamp images. This study proves the potential of the DL model to help ophthalmologists to identify infectious keratitis and improve the accuracy and efficiency of diagnosis.
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Lucyshyn DR, Childs-Sanford SE, Choi E, Ledbetter EC. IN VIVO CONFOCAL MICROSCOPY FOR CHARACTERIZATION OF MYCOTIC KERATITIS IN OWLS ( BUBO SCANDIACUS, STRIX VARIA) AND A WOODCOCK ( SCOLOPAX MINOR): THREE CASES. J Zoo Wildl Med 2023; 54:202-210. [PMID: 36971646 DOI: 10.1638/2022-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 03/29/2023] Open
Abstract
This case series describes the use of in vivo confocal microscopy in the diagnosis and treatment of mycotic keratitis in two owls (one Bubo scandiacus, one Strix varia) and one woodcock (Scolopax minor). Each bird was at increased risk of fungal infection due to recent injury or stress. Ophthalmic findings in all birds included blepharospasm, ocular discharge, ulcerative keratitis, white or yellow corneal plaques, and anterior uveitis. Fungal hyphae were identified in corneal samples from all three eyes examined cytologically and in all three eyes by using in vivo confocal microscopy. Aspergillus fumigatus was isolated from a corneal culture in one bird. Despite medical treatment, progressive ocular disease prompted enucleation in two birds. Fungal hyphae were detected by histopathology in one of the two enucleated eyes. In vivo confocal microscopy aided the diagnosis of fungal keratitis in all birds and was the only diagnostic method that allowed immediate, real-time quantification of the extent (area and depth) and severity of mycotic keratitis.
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Affiliation(s)
- Danica R Lucyshyn
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Sara E Childs-Sanford
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Eunju Choi
- Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Eric C Ledbetter
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA,
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McCoy C, Patel S, Thulasi P. Update on the Management of Acanthamoeba Keratitis. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Jin X, Jin H, Shi Y, Zhang N, Zhang H. Clinical Observation of Corneal Endothelial Plaques With Fungal and Bacterial Keratitis by Anterior Segment Optical Coherence Tomography and In Vivo Confocal Microscopy. Cornea 2022; 41:1426-1432. [PMID: 34759198 PMCID: PMC9555760 DOI: 10.1097/ico.0000000000002912] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Endothelial plaque is an important sign of fungal keratitis and is related to diagnosis, surgical indications, and prognosis. However, bacterial keratitis sometimes involves fibrin formation on the back corneal surface, similar to endothelial plaques. Because corneal infiltration interferes with precise observation of the posterior corneal plaque, distinguishing pathogens with a slitlamp is difficult. We hope to assist clinicians in early diagnosis and timely treatment by observing the connection state of endothelial plaques and the corneal endothelium through anterior segment optical coherence tomography (AS-OCT) and the different forms of endothelial plaques in infectious keratopathy through in vivo confocal microscopy (IVCM). METHODS We analyzed 52 patients in the Eye Hospital of the First Affiliated Hospital of Harbin Medical University who were clearly diagnosed with fungal or bacterial keratitis with endothelial plaques. All patients underwent AS-OCT and IVCM on admission. RESULTS According to the smear, IVCM, or fungal and bacterial culture results, the patients were diagnosed with fungal (28 patients) or bacterial keratitis (24 patients). AS-OCT in 25 patients diagnosed with fungal keratitis revealed that the corneal endothelium-endothelial plaque boundary was unclear and wavy, and 24 patients had unclear cell boundaries and a large number of compactly distributed inflammatory cells in the endothelial layer according to IVCM. AS-OCT in 23 patients diagnosed with bacterial keratitis revealed clear corneal endothelium-endothelial plaque boundaries, and insufficient endothelial cell boundaries with a large number of visible and scattered inflammatory cell structures were observed through IVCM in 22 patients. CONCLUSIONS Corneal endothelial plaque detection by AS-OCT and IVCM can be used for early diagnosis of infectious keratitis.
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Affiliation(s)
- Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin, Heilongjiang Province, People's Republic of China; and
| | - Hao Jin
- Departments of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Yan Shi
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin, Heilongjiang Province, People's Republic of China; and
| | - Nan Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin, Heilongjiang Province, People's Republic of China; and
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin, Heilongjiang Province, People's Republic of China; and
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15
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Shen Z, Zhang Y, Li F, Zhang Q. Case Report: A Rare Fungal Keratitis Caused by Plectosphaerella Cucumerina. Ocul Immunol Inflamm 2022; 31:631-634. [PMID: 35394848 DOI: 10.1080/09273948.2022.2039213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a rare case of fungal keratitis caused by Plectosphaerella cucumerina. METHODS This study retrospectively reviewed the medical records of a case of fungal keratitis. RESULTS Silt-lamp biomicroscopy revealed corneal infiltration and epithelial defects. Anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) were performed to assist in the diagnosis and evaluate corneal conditions. The isolate was identified as Plectosphaerella cucumerina by MALDI-TOF mass spectrometry. The patient was treated with topical 5% pimaricin and oral voriconazole for 1 month and recovered. CONCLUSION Fungal keratitis caused by Plectosphaerella cucumerina is rare. AS-OCT and IVCM can help locate the lesion and diagnose fungal keratitis. Furthermore, MALDI-TOF mass spectrometry showed potential prospects in the identification of filamentous fungi. Plectosphaerella cucumerina rarely infects humans and is sensitive to antifungal agents such as pimaricin and voriconazole.
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Affiliation(s)
- Zhongcheng Shen
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China.,Ophthalmology Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yawei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Fangting Li
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China.,Ophthalmology Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Qin Zhang
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China.,Ophthalmology Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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16
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Bakken IM, Jackson CJ, Utheim TP, Villani E, Hamrah P, Kheirkhah A, Nielsen E, Hau S, Lagali NS. The use of in vivo confocal microscopy in fungal keratitis - Progress and challenges. Ocul Surf 2022; 24:103-118. [PMID: 35278721 DOI: 10.1016/j.jtos.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023]
Abstract
Fungal keratitis (FK) is a serious and sight-threatening corneal infection with global reach. The need for prompt diagnosis is paramount, as a delay in initiation of treatment could lead to irreversible vision loss. Current "gold standard" diagnostic methods, namely corneal smear and culture, have limitations due to diagnostic insensitivity and their time-consuming nature. PCR is a newer, complementary method used in the diagnosis of fungal keratitis, whose results are also sample-dependent. In vivo confocal microscopy (IVCM) is a promising complementary diagnostic method of increasing importance as it allows non-invasive real-time direct visualization of potential fungal pathogens and manifesting infection directly in the patient's cornea. In numerous articles and case reports, FK diagnosis by IVCM has been evaluated, and different features, approaches, sensitivity/specificity, and limitations have been noted. Here, we provide an up-to-date, comprehensive review of the current literature and present the authors' combined recommendations for fungal identification in IVCM images, while also looking to the future of FK assessment by IVCM using artificial intelligence methods.
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Affiliation(s)
- Ingvild M Bakken
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Catherine J Jackson
- Ifocus Eye Clinic, Haugesund, Norway; Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan, Italy; Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Esben Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Scott Hau
- Department of External Disease, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Neil S Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Division of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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17
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Xu F, Jiang L, He W, Huang G, Hong Y, Tang F, Lv J, Lin Y, Qin Y, Lan R, Pan X, Zeng S, Li M, Chen Q, Tang N. The Clinical Value of Explainable Deep Learning for Diagnosing Fungal Keratitis Using in vivo Confocal Microscopy Images. Front Med (Lausanne) 2021; 8:797616. [PMID: 34970572 PMCID: PMC8712475 DOI: 10.3389/fmed.2021.797616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Artificial intelligence (AI) has great potential to detect fungal keratitis using in vivo confocal microscopy images, but its clinical value remains unclarified. A major limitation of its clinical utility is the lack of explainability and interpretability. Methods: An explainable AI (XAI) system based on Gradient-weighted Class Activation Mapping (Grad-CAM) and Guided Grad-CAM was established. In this randomized controlled trial, nine ophthalmologists (three expert ophthalmologists, three competent ophthalmologists, and three novice ophthalmologists) read images in each of the conditions: unassisted, AI-assisted, or XAI-assisted. In unassisted condition, only the original IVCM images were shown to the readers. AI assistance comprised a histogram of model prediction probability. For XAI assistance, explanatory maps were additionally shown. The accuracy, sensitivity, and specificity were calculated against an adjudicated reference standard. Moreover, the time spent was measured. Results: Both forms of algorithmic assistance increased the accuracy and sensitivity of competent and novice ophthalmologists significantly without reducing specificity. The improvement was more pronounced in XAI-assisted condition than that in AI-assisted condition. Time spent with XAI assistance was not significantly different from that without assistance. Conclusion: AI has shown great promise in improving the accuracy of ophthalmologists. The inexperienced readers are more likely to benefit from the XAI system. With better interpretability and explainability, XAI-assistance can boost ophthalmologist performance beyond what is achievable by the reader alone or with black-box AI assistance.
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Affiliation(s)
- Fan Xu
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Li Jiang
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wenjing He
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guangyi Huang
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yiyi Hong
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fen Tang
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jian Lv
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yunru Lin
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yikun Qin
- China-ASEAN Information Harbor Co., Ltd., Nanning, China
| | - Rushi Lan
- Guangxi Key Laboratory of Image and Graphic Intelligent Processing, Guilin University of Electronic Technology, Guilin, China
| | - Xipeng Pan
- Guangxi Key Laboratory of Image and Graphic Intelligent Processing, Guilin University of Electronic Technology, Guilin, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siming Zeng
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Min Li
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qi Chen
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ningning Tang
- Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Research Center of Ophthalmology, Guangxi Academy of Medical Sciences & Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Zemba M, Dumitrescu OM, Dimirache AE, Branisteanu D, Balta F, Burcea M, Moraru A, Gradinaru S. Diagnostic methods for the etiological assessment of infectious corneal pathology (Review). Exp Ther Med 2021; 23:137. [PMID: 35069818 PMCID: PMC8756399 DOI: 10.3892/etm.2021.11060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
Infectious keratitis is a leading cause of visual morbidity, including blindness, all across the globe, especially in developing countries. Prompt and adequate treatment is mandatory to maintain corneal integrity and to recover the best possible final visual acuity. Although in most of the cases practitioners chose to employ empirical broad-spectrum antimicrobial medication that is usually effective, in some instances, they face the need to identify the causative agent to establish the appropriate therapy. An extensive search was conducted on published literature before December 2020 concerning the main laboratory investigations used to identify the microbial agents found in infectious keratitis, their indications, advantages, and disadvantages, as well as the results reported by other studies concerning different diagnostic tools. At present, the gold standard for diagnosis is still considered to be the isolation of microorganisms in cultures, along with the examination of smears, but other newer techniques, such as polymerase chain reaction (PCR), next-generation sequencing (NGS), and in vivo confocal microscopy (IVCM) have gained popularity in the last decades. Currently, these newer methods have proved to be valuable adjuvants in making the diagnosis, but technological advances hold promise that, in the future, these methods will have increased performance and availability, and may become the new gold standard, replacing the classic cultures and smears.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Andreea-Elena Dimirache
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Florian Balta
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Marian Burcea
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Moraru
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sinziana Gradinaru
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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19
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Diagnostic armamentarium of infectious keratitis: A comprehensive review. Ocul Surf 2021; 23:27-39. [PMID: 34781020 PMCID: PMC8810150 DOI: 10.1016/j.jtos.2021.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 01/23/2023]
Abstract
Infectious keratitis (IK) represents the leading cause of corneal blindness worldwide, particularly in developing countries. A good outcome of IK is contingent upon timely and accurate diagnosis followed by appropriate interventions. Currently, IK is primarily diagnosed on clinical grounds supplemented by microbiological investigations such as microscopic examination with stains, and culture and sensitivity testing. Although this is the most widely accepted practice adopted in most regions, such an approach is challenged by several factors, including indistinguishable clinical features shared among different causative organisms, polymicrobial infection, long diagnostic turnaround time, and variably low culture positivity rate. In this review, we aim to provide a comprehensive overview of the current diagnostic armamentarium of IK, encompassing conventional microbiological investigations, molecular diagnostics (including polymerase chain reaction and mass spectrometry), and imaging modalities (including anterior segment optical coherence tomography and in vivo confocal microscopy). We also highlight the potential roles of emerging technologies such as next-generation sequencing, artificial intelligence-assisted platforms. and tele-medicine in shaping the future diagnostic landscape of IK.
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Abstract
Dry eye disease (DED) is a multifactorial disease that represents one of the most common ophthalmologic conditions encountered in everyday clinical practice. Traditional diagnostic tests for DED, such as subjective questionnaires, tear film break-up time and the Schirmer test, are often associated with poor reproducibility and reliability, which make the diagnosis, follow-up, and management of the disease challenging. New advances in imaging technologies enable objective and reproducible measurements of DED parameters, thus making the diagnosis a multimodal imaging-based process. The aim of this review is to summarize all the current and emerging diagnostic tools available for the diagnosis and monitoring of DED, such as non-invasive tear breakup time, thermography, anterior segment optical coherence tomography, meibography, interferometry, in vivo confocal microscopy, and optical quality assessment. Although there is not a gold standard imaging technique, new multi-imaging-integrated devices are precious instruments to help clinicians to better cope with the diagnostic complexity of DED.
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21
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Fungal Keratitis: Diagnostic Characteristics of the Potassium Hydroxide Preparation With Calcofluor White in Northern California. Cornea 2021; 41:347-352. [PMID: 34743097 DOI: 10.1097/ico.0000000000002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The incidence of fungal keratitis demonstrates significant geographic and climatic variation. We report on the characteristics of the potassium hydroxide/calcofluor white (KOH-CFW) preparation observed at a tertiary center in Northern California, a region with a low incidence of fungal keratitis. METHODS Culture-proven cases of microbial keratitis during a 5-year period were retrospectively reviewed. The sensitivity, specificity, and posttest probabilities were determined for the KOH-CFW assay. These results were compared with documented clinical impression and values reported in the literature. RESULTS Three hundred three of 368 episodes of microbial keratitis during the study period documented the results of a fungal culture, KOH-CFW assay, and a clinical impression. Twenty-one (6.9%) of these cultures were positive for fungal organisms. The sensitivity and specificity of the KOH-CFW test were 29% and 93%, respectively. Clinicians' initial clinical impression based solely on patients' history and examination, without the aid of any histopathologic or biochemical test results, demonstrated a sensitivity and specificity of 33% and 89%, respectively. CONCLUSIONS The observed sensitivity and specificity of the KOH-CFW preparation are significantly lower than many previously reported values. In regions with low incidence of fungal keratitis, the KOH-CFW preparation may have diagnostic performance similar to that of the clinical impression formed only on the basis of history and physical examination.
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22
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Burgos-Blasco B, Gegúndez-Fernández JA, Díaz-Valle D. Purpureocillium lilacinum fungal keratitis: Confocal microscopy diagnosis and histopathology correlation. Med Clin (Barc) 2021; 157:398-399. [PMID: 33272685 DOI: 10.1016/j.medcli.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Bárbara Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - José A Gegúndez-Fernández
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Díaz-Valle
- Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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23
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Sha XY, Shi Q, Liu L, Zhong JX. Update on the management of fungal keratitis. Int Ophthalmol 2021; 41:3249-3256. [PMID: 33929644 DOI: 10.1007/s10792-021-01873-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this article is to introduce the recent advance on the studies of fungal keratitis published over past 5 years. METHODS We performed literature review of articles published on PubMed, Google Scholar, CNKI and Web of Science relevant to the diagnosis, pathogenesis and novel treatment of fungal keratitis. RESULTS Excessive inflammation can lead to stromal damage and corneal opacification, hence the research on immune mechanism provides many potential therapeutic targets for fungal keratitis. Many researchers discussed the importance of earlier definitive diagnosis and were trying to find rapid and accurate diagnostic methods of pathogens. Develop new drug delivery systems and new routes of administration with better corneal penetration, prolonged ocular residence time, and better mucoadhesive properties is also one of the research hotspots. Additionally, many novel therapeutic agents and methods have been gradually applied in clinical ophthalmology. CONCLUSION The diagnosis and treatment of fungal keratitis are still a challenge for ophthalmologist, and many researches provide new methods to conquer these problems.
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Affiliation(s)
- Xiao-Yuan Sha
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi Shi
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lian Liu
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jing-Xiang Zhong
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
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Acanthamoeba Keratitis, Pathology, Diagnosis and Treatment. Pathogens 2021; 10:pathogens10030323. [PMID: 33801905 PMCID: PMC7998329 DOI: 10.3390/pathogens10030323] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022] Open
Abstract
Acanthamoeba keratitis is an unusual corneal infection that is recently increasing in frequency and is often contracted by contact lens wearers, someone who experienced recent eye trauma, or someone exposed to contaminated waters. Acanthamoeba survive in air, soil, dust, and water. Therefore, eye trauma and poor contact lens hygiene practices lead to the entrapment of debris and thus infection. Acanthamoeba keratitis results in severe eye pain, inflammation, and defects of the epithelium and stroma that can potentially result in vision loss if not diagnosed early and treated promptly. The disease can be diagnosed using corneal scrape/biopsy, polymerase chain reactions, impression cytology, or in vivo confocal microscopy. Once diagnosed, it is usually treated with an antimicrobial combination therapy of biguanide and aromatic diadine eye drops for several months. Advanced stages of the disease result in vision loss and the need for corneal transplants. Avoiding the risk factors and diagnosing the disease early are the most effective ways to combat Acanthamoeba keratitis.
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Wu J, Xie H. Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review. J Int Med Res 2021; 49:3000605211000985. [PMID: 33752507 PMCID: PMC7995463 DOI: 10.1177/03000605211000985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but severe ocular infection with a significant risk of vision loss. Contact lens use is the main risk factor for AK. The orthokeratology (OK) lens, a specially designed contact lens, has been used worldwide as an effective method of myopia control. However, the OK lens is associated with an increased risk of Acanthamoeba infection. Many primary practitioners are concerned about this infection because of its relative rarity, the lack of promising therapeutic medications, and the need for referral. We herein report two cases of AK associated with OK lenses, present a systematic review of such cases, and discuss the possible reasons for the higher incidence rate of this infection in patients who wear OK lenses. We combined the clinical knowledge and skills of corneal specialists and lens experts with the sole objective of addressing these OK lens-related AK cases. We found that the most common risk factors were rinsing the lenses or lens cases with tap water. Prompt and accurate diagnosis along with adequate amoebicidal treatment are essential to ensure desirable outcomes for OK lens wearers who develop AK. Appropriate OK lens parameters and regular checkups are also important.
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Affiliation(s)
- Jinfang Wu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Analysis of the Microcystic Keratitis. J Ophthalmol 2020; 2020:8871904. [PMID: 33489348 PMCID: PMC7803116 DOI: 10.1155/2020/8871904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear. Methods IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared. Results On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 μm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology. Conclusions Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.
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Poon SHL, Wong WHL, Lo ACY, Yuan H, Chen CF, Jhanji V, Chan YK, Shih KC. A systematic review on advances in diagnostics for herpes simplex keratitis. Surv Ophthalmol 2020; 66:514-530. [PMID: 33186564 DOI: 10.1016/j.survophthal.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
Herpes simplex keratitis (HSK) is a significant cause of vision impairment worldwide. Currently, there are no set diagnostic criteria, and popular diagnostic methods, including clinical examination of the eye via slit lamp examination, could lead to false-negatives and misdiagnoses. Molecular testing with polymerase chain reaction (PCR) may lack concordance with clinical findings, posing a great challenge to ophthalmologists. We evaluate recent studies on techniques for the diagnosis of HSK. We included a total of 23 studies published between 2010 and 2020 in English on diagnostic techniques, including in vivo confocal microscopy, polymerase PCR testing, protein detection in tear film with enzyme-linked immunosorbent assay, and various other protein assays. Although PCR has been widely used as one of the current diagnostic methods for HSK, most studies evaluated its efficacy after including alterations to its normal protocol. Tear sample analysis was performed using multiple tools, although corneal scrapings demonstrated a higher positive detection rate. Diagnostic tools identified were able to detect HSK with varying accuracy. Newer diagnostic techniques like multiplex dot hybridization assay and immunochromatographic assays may be considered as the point-of-care preliminary diagnostic tools. More reliable results may be generated by developing a standardized diagnostic protocol.
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Affiliation(s)
- Stephanie Hiu Ling Poon
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - William Ho Lam Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Hao Yuan
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Chien-Fu Chen
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yau Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR.
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Schmidl D, Schlatter A, Chua J, Tan B, Garhöfer G, Schmetterer L. Novel Approaches for Imaging-Based Diagnosis of Ocular Surface Disease. Diagnostics (Basel) 2020; 10:diagnostics10080589. [PMID: 32823769 PMCID: PMC7460546 DOI: 10.3390/diagnostics10080589] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Imaging has become indispensable in the diagnosis and management of diseases in the posterior part of the eye. In recent years, imaging techniques for the anterior segment are also gaining importance and are nowadays routinely used in clinical practice. Ocular surface disease is often synonymous with dry eye disease, but also refers to other conditions of the ocular surface, such as Meibomian gland dysfunction or keratitis and conjunctivitis with different underlying causes, i.e., allergies or infections. Therefore, correct differential diagnosis and treatment of ocular surface diseases is crucial, for which imaging can be a helpful tool. A variety of imaging techniques have been introduced to study the ocular surface, such as anterior segment optical coherence tomography, in vivo confocal microscopy, or non-contact meibography. The present review provides an overview on how these techniques can be used in the diagnosis and management of ocular surface disease and compares them to clinical standard methods such as slit lamp examination or staining of the cornea or conjunctiva. Although being more cost-intensive in the short term, in the long term, the use of ocular imaging can lead to more individualized diagnoses and treatment decisions, which in turn are beneficial for affected patients as well as for the healthcare system. In addition, imaging is more objective and provides good documentation, leading to an improvement in patient follow-up and education.
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Affiliation(s)
- Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (A.S.); (G.G.)
| | - Andreas Schlatter
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (A.S.); (G.G.)
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery-Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Nanyang Technological University, Singapore 639798, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Nanyang Technological University, Singapore 639798, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (A.S.); (G.G.)
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (A.S.); (G.G.)
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Nanyang Technological University, Singapore 639798, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-29810; Fax: +43-1-40400-29990
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Bagga B, Sharma S, Gour RPS, Mohamed A, Joseph J, M Rathi V, Garg P. A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis. Eye (Lond) 2020; 35:1326-1333. [PMID: 32719525 DOI: 10.1038/s41433-020-1109-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK). METHODS This is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity. RESULTS Out of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3-6.5 mm) (p = 0.02) to 1 mm (IQR, 0-4.3 mm) in group BG and from 4.5 mm (IQR, 1.8-5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0-1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48-2.78) to 1.10 (IQR, 0.48-1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00-2.78) to 0.80 (IQR, 0.48-1.30) in VZ group (p = 0.18). CONCLUSION These outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.
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Affiliation(s)
- Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Roth M, Daas L, MacKenzie CR, Balasiu A, Stachon T, Neumann I, Steindor F, Seitz B, Geerling G. Development and Assessment of a Simulator for in Vivo Confocal Microscopy in Fungal and Acanthamoeba Keratitis. Curr Eye Res 2020; 45:1484-1489. [PMID: 32434387 DOI: 10.1080/02713683.2020.1772830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE In vivo confocal microscopy (IVCM) is a non-invasive imaging technique that allows morphological analysis as a diagnostic approach of the cornea in real time, thus providing a suspected diagnosis of fungal or amoebic keratitis immediately, whereas culture or PCR require several days or even weeks. Since these infections are rare, it is difficult for ophthalmologists to gain the experience necessary to differentiate infection from normal findings or artefacts. The purpose of this project was to establish a simulator, on which physicians could practice as well as acquiring a database of IVCM images of fungal or amoebic keratitis and respective analyses. PATIENTS AND METHODS An IVCM simulator was set up with cadaver human corneas, infected with either acanthamoeba, candida or aspergillus. Twenty-one ophthalmologists were trained in IVC microscopy first in a Dry Lab, then practically on the simulator. For evaluation, the participants were asked to fill out a standardized questionnaire, with a pre- and post-course self-assessment. RESULTS The self-assessed theoretical and practical skills in differentiating infectious from non-infectious keratitis in IVCM significantly increased (p = 0.0001, p = 0.0002, respectively). The barrier to use this technique decreased (p = 0.0474). CONCLUSION A very simple protocol based on a model of ex vivo corneal mycotic and amoebic infections can be used to train novices in the structured approach and diagnostic use of IVCM for corneal infections.
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Affiliation(s)
- M Roth
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - L Daas
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - C R MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine University , Düsseldorf, Germany
| | - A Balasiu
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine University , Düsseldorf, Germany
| | - T Stachon
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - I Neumann
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - F Steindor
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - B Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - G Geerling
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
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