2010 OMIG, Abstract 6

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Confocal interpretation compared with clinical and microbiological findings in atypical keratitis: review of 64 cases
P.B. Wall, T.F. Mauger, R.A. Kuennen, A.J. Hendershot
The Ohio State University Medical Center, Dept. of Ophthalmology, Columbus, OH

Purpose: To evaluate the utility of confocal microscopy in the identification of fungal and acanthamoeba infections.
Methods: Confocal scans performed at OSU from 2002 through 2009 were read by three physicians.  A retrospective case review of patients who had undergone confocal microscopy was performed.  Patients were determined to be positive or negative for infection based on clinical impression, outcome, and culture, which was then compared to confocal readings.
Results: Out of 101 studies and charts reviewed, the inclusion criteria were met by 64 confocal microscopy studies which had specifically been done to look for infectious keratitis and had sufficient follow up to determine the efficacy of treatment.  Confocal microscopy identified fungal or acanthamoeba keratitis with 66% sensitivity and 71% specificity when considering a positive reading by two physicians to be positive overall.  Cultures were positive in 36% of patients who were clinically determined to have fungal or acanthamoeba keratitis.
Conclusion: Atypical corneal infections are difficult to diagnose due to the low yield and slow growth on culture and frequent clinical misdiagnosis leading to a delay in treatment.  Confocal microscopy is helpful in diagnosis of acanthamoeba and fungal keratitis, but it should be used as an adjunct to clinical judgement and culture.

Disclosure Code: Protocol number 2010E0082