SCIENTIFIC REPORT

In vivo confocal microscopy in fungal keratitis

Emmanuelle Brasnu¹, Tristan Bourcier², Bénédicte Dupas¹, Sandrine Degorge³, Thibault Rodallec⁴, Laurent Laroche⁵, Vincent Borderie⁵ and Christophe Baudouin⁶

¹ Department of Ophthalmology III, Quinze-Vingts National Center of Ophthalmology, Paris, France
² Department of Ophthalmology, Strasbourg Universitary Hospital, Strasbourg, France
³ Quinze-Vingts National Center of Ophthalmology, Laboratory, Paris, France
⁴ Department of Ophthalmology II, Quinze-Vingts National Center of Ophthalmology, Paris, France
⁵ Department of Ophthalmology V, Quinze-Vingts National Center of Ophthalmology, Paris, France
⁶ Quinze-Vingts National Center of Ophthalmology, Department of Ophthalmology III, Paris, France; INSERM, UMR S 872, Cordeliers Biomedical Institute, Paris Descartes and Pierre et Marie Curie Universities, Paris, France

Correspondence to:
Correspondence to:
Professor C Baudouin
Hôpital des Quinze-Vingts, Service III, 28 rue de Charenton, 75012 Paris, France; baudouin{at}quinze-vingts.fr

Background: Fungal keratitis is a major blinding eye disease found throughout the world, particularly in developing countries. Given the recent increase in Fusarium keratitis infections in contact lens wearers owing to contact lens solutions, a warning was recently issued by the Food and Drug Administration, making it a public health concern in developed countries.

Objective: To show the advantages of in vivo confocal microscopy imaging using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) in the early diagnosis of fungal keratitis.

Methods: HRTII-RCM confocal microscopy was performed on five patients presenting with fungal keratitis and on three donor corneas contaminated with Fusarium solani, Aspergillus fumigatus and Candida albicans.

Results: Direct microscopic evaluation of corneal smears and culture revealed the presence of F solani in four cases and C albicans in one case. HRTII-RCM examination of the infected patients and contaminated donor corneas revealed numerous high-contrast elements resembling Fusarium, Aspergillus hyphae or Candida pseudofilaments in the anterior stroma.

Conclusion: HRTII-RCM in vivo confocal microscopy is a new, non-invasive and rapid technique for the early diagnosis of fungal keratitis, showing high-resolution images resembling fungal structures in the early phase of the disease.

Abbreviations: FK, fungal keratitis; HRTII-RCM, Heidelberg Retina Tomograph II-Rostock Cornea Module

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