Tu Elmer Y, Joslin Charlotte E, Sugar Joel, Booton Gregory C, Shoff Megan E, Fuerst Paul A
Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL 60612, USA.
Cornea. 2008 Aug;27(7):764-72. doi: 10.1097/ICO.0b013e31816f27bf.
To compare the relative diagnostic value of confocal microscopy and superficial corneal cultures in the diagnosis of Acanthamoeba keratitis by using clinical and microbiologic definitions of disease.
Results of confocal microscopy, superficial corneal smear, and superficial corneal culture were analyzed for validity against 2 different microbiologic and a clinical composite standard for Acanthamoeba keratitis.
In patients with both clinical characteristics and objective evidence of Acanthamoeba keratitis, confocal microscopy exhibited a sensitivity of 90.6% (95% confidence interval [CI]: 79.3%-96.9%) and a specificity of 100% (95% CI: 95.0%-100%). In patients with either positive culture or smear evidence of Acanthamoeba keratitis, confocal microscopy showed a sensitivity of 90.9% (95% CI: 78.3%-97.5%) and specificity of 90.1% (95% CI: 81.5%-95.6%). In strictly culture-positive patients, confocal microscopy showed a sensitivity of 92.9% (95% CI: 76.5%-99.1%) and a specificity of 77.3% (95% CI: 67.7%-85.2%). Of the 53 patients with Acanthamoeba keratitis, confocal microscopy was positive in 48 patients, whereas corneal smears and cultures were positive in 30 of 41 and 23 of 42 patients, respectively. Sensitivity of Acanthamoeba culture was 52.8% (95% CI: 38.6%-66.7%) in patients with a clinical diagnosis of Acanthamoeba keratitis. Simultaneous testing of smear and superficial corneal scraping resulted in a sensitivity of 83.0% (95% CI: 70.2%-91.9%), independent of the results of confocal microscopy.
As confocal microscopy comes into wider clinical use, it remains in need of clinical and pathologic correlation. When performed and interpreted by an experienced operator, confocal microscopy is both sensitive and specific in the diagnosis of Acanthamoeba keratitis. Contemporaneous corneal scrapings are independently sensitive in the detection of Acanthamoeba keratitis, and a combination of both diagnostic modalities offers the highest likelihood of rapidly and accurately diagnosing Acanthamoeba keratitis in patients with atypical keratitis.
通过使用疾病的临床和微生物学定义，比较共聚焦显微镜检查和表层角膜培养在棘阿米巴角膜炎诊断中的相对诊断价值。
分析共聚焦显微镜检查、表层角膜涂片和表层角膜培养的结果，以对照棘阿米巴角膜炎的2种不同微生物学标准和1种临床综合标准来评估其有效性。
在具有棘阿米巴角膜炎临床特征和客观证据的患者中，共聚焦显微镜检查的敏感性为90.6%（95%置信区间[CI]：79.3%-96.9%），特异性为100%（95%CI：95.0%-100%）。在棘阿米巴角膜炎培养或涂片证据阳性的患者中，共聚焦显微镜检查的敏感性为90.9%（95%CI：78.3%-97.5%），特异性为90.1%（95%CI：81.5%-95.6%）。在严格培养阳性的患者中，共聚焦显微镜检查的敏感性为92.9%（95%CI：76.5%-99.1%），特异性为77.3%（95%CI：67.7%-85.2%）。在53例棘阿米巴角膜炎患者中，共聚焦显微镜检查48例呈阳性，而角膜涂片和培养分别在41例中的30例和42例中的23例呈阳性。在临床诊断为棘阿米巴角膜炎的患者中，棘阿米巴培养的敏感性为52.8%（95%CI：38.6%-66.7%）。涂片和表层角膜刮片同时检测的敏感性为83.0%（95%CI：70.2%-91.9%），与共聚焦显微镜检查结果无关。
随着共聚焦显微镜检查在临床中更广泛地应用，它仍需要与临床和病理进行相关性研究。由经验丰富的操作人员进行并解读时，共聚焦显微镜检查在棘阿米巴角膜炎的诊断中既敏感又特异。同期角膜刮片在棘阿米巴角膜炎的检测中具有独立的敏感性，两种诊断方式联合使用可使非典型角膜炎患者快速准确诊断棘阿米巴角膜炎的可能性最高。
