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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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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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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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Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty. Cornea 2021; 41:396-401. [PMID: 34690262 DOI: 10.1097/ico.0000000000002880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis. METHODS A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations. RESULTS A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients. CONCLUSIONS After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
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Chopra R, Mulholland PJ, Hau SC. In Vivo Confocal Microscopy Morphologic Features and Cyst Density in Acanthamoeba Keratitis. Am J Ophthalmol 2020; 217:38-48. [PMID: 32278770 DOI: 10.1016/j.ajo.2020.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To correlate in vivo confocal microscopy morphologic features (IVCM-MF) and Acanthamoeba cyst density (ACD) with final best-corrected visual acuity (BCVA) in Acanthamoeba keratitis (AK). DESIGN Retrospective cohort study. METHODS Patient demographics, treatment outcome, and corresponding IVCM-MF performed at the acute stage of infection were analyzed. Inclusion criteria were microbiological positive AK cases seen at Moorfields Eye Hospital between February 2013 and October 2017. Statistical significance was assessed by multinomial regression and multiple linear regression analysis. Main outcome measure was final BCVA. RESULTS A total of 157 eyes (157 patients) had AK. Absence of single-file round/ovoid objects was associated with a BCVA of 6/36 to 6/9 (odds ratio [OR] 8.13; 95% confidence interval [CI], 1.55-42.56, P = .013) and ≥6/6 (OR 10.50; 95% CI, 2.12-51.92, P = .004) when compared to no perception of light to 6/60. Absence of rod/spindle objects was associated with a BCVA of ≥6/6 (OR 4.55; 95% CI, 1.01-20.45, P = .048). Deep stromal/ring infiltrate was associated with single-file round/ovoid objects (OR 7.78; 95% CI, 2.69-22.35, P < .001), rod/spindle objects (OR 7.05; 95% CI, 2.11-23.59, P = .002), and binary round/ovoid objects (OR 3.45; 95% CI, 1.17-10.14, P = .024). There was a positive association between ACD and treatment duration (β = 0.14, P = .049), number of IVCM-MF (β = 0.34, P = .021), and clusters of round/ovoid objects (β = 0.29, P = .002). CONCLUSIONS Specific IVCM-MF correlate with ACD and clinical staging of disease, and are prognostic indicators for a poorer visual outcome.
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Li S, Bian J, Wang Y, Wang S, Wang X, Shi W. Clinical features and serial changes of Acanthamoeba keratitis: an in vivo confocal microscopy study. Eye (Lond) 2019; 34:327-334. [PMID: 31292523 DOI: 10.1038/s41433-019-0482-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/10/2018] [Accepted: 04/02/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To observe the clinical features and serial changes of Acanthamoeba keratitis (AK) during medical treatment by using confocal microscopy. METHODS Thirty-seven patients (37 eyes) diagnosed with AK were included in this study. Confocal microscopy was used to observe the morphology, distribution, and density of Acanthamoeba cysts before and after medication. The differences between cysts and inflammatory cells were identified. RESULTS Acanthamoeba cysts were detected at a rate of 94.6% (35/37) by repeated confocal microscopic examinations. The cysts consisting of a lowly light-reflective wall and a high-refractive nucleus, showed cluster or chain distribution in the corneal stroma, which was different from inflammatory cells. After medical therapy, the nucleus of cysts or peripheral corneal tissue gradually dissolved to a hollow configuration. Some of the hollow cysts existed for up to 6 months. The quantity of cysts increased after 1-2 weeks of medication in 23 patients (62.1%), and then began to decrease in 13 patients (35.1 %) who were responsive to anti-amoebic treatment. CONCLUSION Acanthamoeba cysts have many typical clinical features that can be identified by confocal microscopy, which may serve as a valuable tool to guide clinical evaluation and treatment of AK.
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Affiliation(s)
- Suxia Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China.,Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jiang Bian
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yuting Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Shuting Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xin Wang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Weiyun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China. .,Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
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Chidambaram JD, Prajna NV, Palepu S, Lanjewar S, Shah M, Elakkiya S, Macleod D, Lalitha P, Burton MJ. In Vivo Confocal Microscopy Cellular Features of Host and Organism in Bacterial, Fungal, and Acanthamoeba Keratitis. Am J Ophthalmol 2018; 190:24-33. [PMID: 29550185 PMCID: PMC5972002 DOI: 10.1016/j.ajo.2018.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine cellular features of fungal (FK), Acanthamoeba (AK), and bacterial keratitis (BK) using HRT3 in vivo confocal microscopy (IVCM). DESIGN Prospective observational cross-sectional study. METHODS Eligible participants were adults with microbiologically positive FK, AK, or BK, of size ≥ 3 mm, attending Aravind Eye Hospital from February 2012 to February 2013. Exclusion criteria were descemetocele or perforation. At presentation, IVCM imaging was performed, then corneal scrapes were obtained for culture/light microscopy. An experienced grader (masked to microbiology/clinical features) assessed IVCM images for presence/absence of normal keratocyte-like morphology, stellate interconnected cells with/without visible nuclei, dendritiform cells (DFCs), inflammatory cells in a honeycomb distribution, and organism features. Statistical significance was assessed by logistic regression, adjusted for age, sex, ulcer size, and symptom duration. Main outcome measures were presence/absence of IVCM features in FK, AK, BK. RESULTS A total of 183 participants had FK, 18 AK, 17 BK. Acanthamoeba appeared as bright spots (16/18, 89%), double-walled cysts (15/18, 83%), or signet rings (3/18, 17%), and often formed clusters after topical steroid use (univariable odds ratio [OR] 9.98, 95% confidence interval [CI] 1.02-97.96, P = .048). BK was associated with bullae in anterior stroma (OR 9.99, 95% CI: 3.11-32.06, P < .001). Honeycomb distribution of anterior stromal inflammatory cells was associated with FK (univariable OR 2.74, 95% CI: 1.01-7.40, P = .047). Aspergillus ulcers were associated with stromal DFCs (OR 11.05, 95% CI: 1.49-82.13, P = .019) and Fusarium ulcers with stellate appearance of interconnected cell processes with nuclei (OR 0.24, 95% CI: 0.09-0.65, P = .005). CONCLUSION Specific cellular and structural features observed using IVCM in microbial keratitis may be associated with organism.
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Affiliation(s)
- Jaya D Chidambaram
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | | | | | - Manisha Shah
- Aravind Medical Research Foundation, Madurai, India
| | | | - David Macleod
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Prajna Lalitha
- Aravind Eye Hospital, Madurai, India; Aravind Medical Research Foundation, Madurai, India
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Cornea Department, Moorfields Eye Hospital, London, United Kingdom
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De Craene S, Knoeri J, Georgeon C, Kestelyn P, Borderie VM. Assessment of Confocal Microscopy for the Diagnosis of Polymerase Chain Reaction-Positive Acanthamoeba Keratitis: A Case-Control Study. Ophthalmology 2017; 125:161-168. [PMID: 28965660 DOI: 10.1016/j.ophtha.2017.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine in vivo confocal microscopy diagnostic criteria to diagnose Acanthamoeba keratitis (AK) using polymerase chain reaction (PCR) as the reference diagnostic technique. DESIGN Retrospective case-control study. Data were recorded prospectively and analyzed retrospectively. PARTICIPANTS Fifty patients with PCR-positive AK (study group) and 50 patients with bacterial, fungal, viral, or immune keratitis featuring negative Acanthamoeba PCR results (control group). METHODS In vivo confocal microscopy performed at the acute stage of keratitis. MAIN OUTCOME MEASURES Presence of in vivo confocal microscopy images suggestive of AK. Multivariate logistic regression was used to determine the relationship between types of images and presence of PCR-positive AK. RESULTS The following 4 types of images were associated significantly with PCR-positive AK (P < 0.05): bright spots (round or ovoid hyperreflective objects with no double wall; diameter, <30 μm); target images (hyperreflective objects with hyporeflective halo; diameter, <30 μm); clusters of hyperreflective objects (diameter, <30 μm); and trophozoite-like objects (diameter, >30 μm). Specificity of both target and trophozoite images was 100%. This figure was 98.2% for clusters and 48.2% for bright spots. If the diagnosis of AK was made on presence of target images, clusters or trophozoite images (at least 1 of the 3 features), the positive predictive value of confocal microscopy was 87.5% and the negative predictive value was 58.5%. CONCLUSIONS Acanthamoeba keratitis is a serious vision-threatening disease. In vivo confocal microscopy can help in this challenging diagnosis, especially when PCR is delayed, shows negative results, or is not available. Target images and trophozoite-like images are pathognomonic of AK. Clusters of hyperreflective objects are highly specific of AK. However, the overall sensitivity of in vivo confocal microscopy features of AK is low. In addition to the clinical features, microbiological tests (direct examination and cultures of corneal scrapings), and PCR, in vivo confocal microscopy allows for more rapid diagnosis and treatment initiation, potentially leading to an improved outcome.
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Affiliation(s)
| | - Juliette Knoeri
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France
| | - Cristina Georgeon
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France
| | | | - Vincent M Borderie
- Federation of Ocular Infectious Diseases, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France; Institut de la Vision, INSERM, University Paris, Paris, France.
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Bouheraoua N, Labbé A, Chaumeil C, Liang Q, Laroche L, Borderie V. [Acanthamoeba keratitis]. J Fr Ophtalmol 2014; 37:640-52. [PMID: 25169145 DOI: 10.1016/j.jfo.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
Early diagnosis and appropriate therapy are key elements for a good prognosis in Acanthamoeba keratitis (AK). AK should be considered in any case of corneal trauma complicated by exposure to soil or contaminated water, and in all contact lens (CL) wearers. A presumptive diagnosis of AK can be made clinically and with in vivo confocal microscopy, although a definitive diagnosis requires identification of Acanthamoeba on direct scraping, histology, or identification of Acanthamoeba DNA by polymerase chain reaction (PCR). We use cysticidal drugs for treating AK because encysted forms are more resistant than trophozoites to treatment. The treatment protocol used a biguanide (PHMB 0.02% or chlorhexidine 0.02%) and a diamidine (propamidine 0.1% or hexamidine 0.1%). New diagnostic modalities and more specific topical anti-amoebic treatments would substantially benefit patients with AK.
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Affiliation(s)
- N Bouheraoua
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France.
| | - A Labbé
- Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie 3, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, DHU View maintain, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Chaumeil
- Service de biologie médicale, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - Q Liang
- Beijing Institute of Ophthalmology, Beijing TongRen Eye Center, Beijing TongRen Hospital, Capital Medical University, Beijing, Chine
| | - L Laroche
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
| | - V Borderie
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
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Tahiri Joutei Hassani R, Liang H, El Sanharawi M, Brasnu E, Kallel S, Labbé A, Baudouin C. En-face optical coherence tomography as a novel tool for exploring the ocular surface: a pilot comparative study to conventional B-scans and in vivo confocal microscopy. Ocul Surf 2014; 12:285-306. [PMID: 25284774 DOI: 10.1016/j.jtos.2014.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To explore the potential of spectral-domain optical coherence tomography (SD-OCT) using the en-face technology for the imaging of ocular surface diseases and to correlate the findings with in vivo confocal microscopy (IVCM) images. PATIENTS AND METHODS 113 eyes of 75 subjects with various ocular surface diseases were investigated with the RTVue(®) anterior-segment en face OCT. En face OCT images were compared to B-scan OCT and IVCM images. RESULTS Patients with corneal dystrophies, corneal deposits, keratitis, pterygium, conjunctivochalasis, or ocular surface squamous neoplasia and patients who underwent lamellar corneal surgeries were included. En-face OCT images showed ocular surface tissue changes that were not discernible using conventional B-scan OCT. Nevertheless, there was a good correlation with IVCM analysis. Compared with IVCM, the major advantages of en-face OCT included easy operation and rapid image acquisition, with minimal operator experience required. In addition, the non-contact method avoided patient discomfort and external pressure on the globe, which was especially useful in patients with corneal dystrophies, ulcers, or corneal abscesses. Although the resolution of en-face OCT was lower than that of IVCM, it allowed useful overall visualization of corneal lesions due to the larger areas analyzed. CONCLUSION En-face SD-OCT is a novel, valuable tool to assess a wide variety of ocular surface diseases. It can provide additional information and new insight into different ocular surface conditions with no corneal contact.
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Affiliation(s)
- Rachid Tahiri Joutei Hassani
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center, Paris
| | - Hong Liang
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center, Paris; INSERM, U968, Paris, F-75012, UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, Paris F-75012; CNRS, UMR_7210, Paris F-75012, France
| | - Mohamed El Sanharawi
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris
| | - Emmanuelle Brasnu
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center, Paris
| | - Sofiene Kallel
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UFR Paris-île de France Ouest, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Antoine Labbé
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center, Paris; INSERM, U968, Paris, F-75012, UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, Paris F-75012; CNRS, UMR_7210, Paris F-75012, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UFR Paris-île de France Ouest, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Christophe Baudouin
- Department of Ophthalmology, 3 Quinze-Vingts National Ophthalmology Hospital, Paris; Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center, Paris; INSERM, U968, Paris, F-75012, UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, Paris F-75012; CNRS, UMR_7210, Paris F-75012, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UFR Paris-île de France Ouest, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.
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