Guo X Y, Wang Z Q, Chen K X, Zhang Y, Wei Z Y, Liang Q F
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2023 Apr 11;59(4):279-287. doi: 10.3760/cma.j.cn112142-20221001-00480.
To analyze the clinical manifestations and imaging characteristics of confocal microscopy (IVCM) for keratitis. It was a retrospective case series study. Medical records of 16 consecutive patients (16 eyes) with keratitis were collected from the Department of Ophthalmology at Beijing Tongren Hospital, Capital Medical University between 2018 and 2022. The group consisted of 11 males and 5 females. The inclusion criteria for the study were the presence of typical clinical manifestations of keratitis and at least one positive pathogenic test (corneal scraping or microbial culture) indicating infection. The medical history, clinical and microbiological examination data of the patients were analyzed, including risk factors, diagnosis time, clinical manifestations, diagnostic methods, strain isolation, cure time, and best corrected visual acuity before and after treatment. This study utilized techniques such as slit lamp microscopy, confocal microscopy (IVCM), scraping cytology, microbial culture, and mass spectrometry identification. The main risk factors for keratitis included plant or foreign body injuries (5 out of 16 cases), contact lens use (4 out of 16 cases), and surgery (2 out of 16 cases). The average time to diagnosis was (20.8±11.8) days, with the shortest time being 8 days and the longest being 60 days. The best corrected visual acuity was less than 0.05 in 7 patients, between 0.05 to 0.3 in 7 patients, and greater than or equal to 0.3 in 2 patients. The typical symptoms included superficial gray-white infiltration in a wreath-like pattern on the cornea, corneal ulcers with dry and gray-white necrotic tissue coverage, and in severe cases, corneal ulcer perforation. corneal infection was identified in 12 out of 16 cases by scraping cytology, 9 out of 16 cases by mass spectrometry, and 8 out of 16 cases by both methods. IVCM showed the presence of fine and moderately reflective filamentous hyphae in the subepithelial and superficial stromal layer of the cornea, arranged in elongated, beaded, and branched structures. Infiltration of many hyper-reflective round inflammatory cells was also seen around the hyphae. Fourteen cases were treated with medication and 2 cases were treated with corneal transplantation. The average cure time was (37.5±25.2) days and there were no cases of recurrence during the follow-up period (all greater than 6 months). keratitis is primarily characterized by dense, round, or wreath-like infiltration in the early stage, and by gray-white dry necrotic secretion and hypopyon on the surface of corneal ulcers in the middle and late stages. Fine, branched or beaded, and moderately reflective filamentous structures are the hallmark of the corneal lesion on the IVCM images.
分析共焦显微镜（IVCM）用于角膜炎检查的临床表现及影像学特征。这是一项回顾性病例系列研究。收集了2018年至2022年期间首都医科大学附属北京同仁医院眼科连续16例（16只眼）角膜炎患者的病历资料。该组患者中男性11例，女性5例。本研究的纳入标准为存在典型的角膜炎临床表现且至少一项致病检测（角膜刮片或微生物培养）呈阳性以提示感染。分析患者的病史、临床及微生物学检查数据，包括危险因素、诊断时间、临床表现、诊断方法、菌株分离、治愈时间以及治疗前后的最佳矫正视力。本研究采用了裂隙灯显微镜检查、共焦显微镜（IVCM）检查、刮片细胞学检查、微生物培养及质谱鉴定等技术。角膜炎的主要危险因素包括植物或异物损伤（16例中有5例）、佩戴隐形眼镜（16例中有4例）及手术（16例中有2例）。平均诊断时间为（20.8±11.8）天，最短8天，最长60天。7例患者的最佳矫正视力低于0.05，7例患者的最佳矫正视力在0.05至0.3之间，2例患者的最佳矫正视力大于或等于0.3。典型症状包括角膜呈花环样灰白色浅层浸润、角膜溃疡表面覆盖干燥灰白色坏死组织，严重时出现角膜溃疡穿孔。16例中有12例通过刮片细胞学检查确诊角膜感染，16例中有9例通过质谱鉴定确诊，16例中有8例通过两种方法均确诊。IVCM显示角膜上皮下及浅层基质层存在纤细、中度反光的丝状菌丝，呈细长、串珠状及分支状排列。在菌丝周围还可见许多高反光圆形炎性细胞浸润。14例患者接受药物治疗，2例患者接受角膜移植治疗。平均治愈时间为（37.5±25.2）天，随访期间（均超过6个月）无复发病例。角膜炎早期主要表现为密集的圆形或花环样浸润，中晚期表现为角膜溃疡表面灰白色干燥坏死分泌物及前房积脓。纤细、分支或串珠状、中度反光的丝状结构是IVCM图像上角膜病变的特征。
