Kaufman Stephen C, Musch David C, Belin Michael W, Cohen Elisabeth J, Meisler David M, Reinhart William J, Udell Ira J, Van Meter Woodford S
Ophthalmology. 2004 Feb;111(2):396-406. doi: 10.1016/j.ophtha.2003.12.002.
To review the available evidence for the use of confocal microscopy in diagnosing infectious keratitis and for other applications for ophthalmic practice.
A MEDLINE search of the peer-reviewed literature for the years 1990 to 2001 yielded 94 citations. The search was limited to studies of human subjects published in English with abstracts. The Ophthalmic Technology Assessment Committee Cornea Panel evaluated these 94 articles for possible clinical relevance and selected 51 (54%) for content review by the panel members. Of these 51 articles, 24 were selected for the panel methodologist to review and rate according to the strength of evidence.
Of the 24 articles, 21 (87.5%) were classified as case reports or case series and were rated as level III evidence. Three articles were classified as independent, masked, or objective comparisons performed in a narrow spectrum of patients or in a nonconsecutive series of patients and were rated as level II evidence. No studies were rated as level I evidence, defined as an independent masked comparison of an appropriate spectrum of consecutive patients.
Confocal microscopy is a new technology with clinical applications in ophthalmology. Although confocal microscopy has been used in other fields of medicine, the optical transparency of the cornea and other structures of the eye provides a unique opportunity to apply this technology. The targeted literature review of 24 articles found no level I studies to support the use of confocal microscopy in the management of eye disorders. Three level II studies pertained to promising clinical applications of the confocal microscope and provided evidence that supports the use of confocal microscopy as an adjunctive modality for diagnosing Acanthamoeba keratitis. The remaining 21 articles, rated as level III evidence, focus on the use of confocal microscopy to facilitate the diagnosis of infectious keratitis, including amoebic and fungal, but currently there are no definitive studies of its role in the differential diagnosis of this condition. There are also level III studies that support the use of the confocal microscope in refractive surgery. Facilitating the diagnosis of infectious keratitis and applying the confocal microscope to refractive surgery may hold the greatest promise of this new technology.
回顾共聚焦显微镜在诊断感染性角膜炎及眼科其他应用方面的现有证据。
对1990年至2001年的同行评审文献进行MEDLINE检索，获得94篇引文。检索限于以英文发表且带有摘要的人体研究。眼科技术评估委员会角膜小组评估了这94篇文章的可能临床相关性，并挑选了51篇（54%）供小组成员进行内容审查。在这51篇文章中，24篇被挑选出来供小组方法学家根据证据强度进行审查和评级。
在这24篇文章中，21篇（87.5%）被归类为病例报告或病例系列，被评为三级证据。三篇文章被归类为在一小部分患者或非连续系列患者中进行的独立、盲法或客观比较，被评为二级证据。没有研究被评为一级证据，一级证据定义为对适当范围的连续患者进行的独立盲法比较。
共聚焦显微镜是一种在眼科有临床应用的新技术。尽管共聚焦显微镜已在医学的其他领域使用，但角膜和眼睛其他结构的光学透明度为应用该技术提供了独特机会。对24篇文章的针对性文献综述未发现一级研究支持在眼部疾病管理中使用共聚焦显微镜。三项二级研究涉及共聚焦显微镜有前景的临床应用，并提供了支持将共聚焦显微镜用作诊断棘阿米巴角膜炎辅助手段的证据。其余21篇文章被评为三级证据，重点是使用共聚焦显微镜促进感染性角膜炎的诊断，包括阿米巴性和真菌性，但目前尚无关于其在该病鉴别诊断中作用的确定性研究。也有三级研究支持在屈光手术中使用共聚焦显微镜。促进感染性角膜炎的诊断以及将共聚焦显微镜应用于屈光手术可能是这项新技术最有前景的应用。
