In Vivo Laser Confocal Microscopy Findings of Radial Keratoneuritis in Patients with Early Stage Acanthamoeba Keratitis

Kobayashi, Akira; Yokogawa, Hideaki; Yamazaki, Natsuko; Ishibashi, Yutaka; Oikawa, Yosaburo; Tokoro, Masaharu; Sugiyama, Kazuhisa

doi:10.1016/j.ophtha.2012.12.038

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…RK is considered an early pathognomonic presentation of AK. [ 9 10 11 12 ] Several studies, including the present one, have used IVCM to detect Acanthamoeba cysts and trophozoites, the honeycomb pattern of active keratocytes, infiltration of inflammatory cells, and highly reflective spindle-shaped structures representative of RK. [ 6 9 ] The present study showed that Acanthamoeba cysts and trophozoites can be observed in the basal epithelial and stromal layers [Figs.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 ] A study by Kobayashi et al . used the HRT laser IVCM system to detect corneal pathological changes in 13 eyes with RK[ 9 ] and found that Acanthamoeba cysts existed almost exclusively in the basal epithelial cell layer. No stromal or nerve infiltration by Acanthamoeba cysts and trophozoites was found and it was concluded that RK may be mediated by inflammatory molecules such as cytokines that are released by the Acanthamoeba localized in the corneal epithelium.…”

Section: Discussionmentioning

confidence: 99%

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Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis

Hung

Liu

et al. 2020

Indian J Ophthalmol

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Purpose: Radial keratoneuritis (RK) is a common feature of Acanthamoeba keratitis (AK). In vivo confocal microscopy (IVCM) is noninvasive and provides real-time images for the diagnosis of corneal diseases by allowing the visualization of corneal structures and morphologies of living organisms at the cellular level. Images of AK with RK obtained using commercial white light IVCM devices have not been frequently evaluated. In the present study, a white light IVCM device was used to evaluate the corneal findings and describe spatial changes in the corneal nerves at different depths in cases of early-stage AK with RK. Methods: In this retrospective, observational study, white light IVCM images focused on RK were evaluated for Acanthamoeba cysts/trophozoites, corneal deposits, and altered corneal nerves, with special emphasis on three-dimensional spatial changes in the corneal nerves at different depths. Results: Seventeen eyes of 17 patients exhibiting early-stage AK with RK were included in the study. Acanthamoeba cysts/trophozoites were observed in the corneal epithelium of 13 eyes and stroma of 7 eyes. Alterations in the corneal nerve morphology and density were observed from the basal epithelial layer to the stromal layer in 12 eyes. Acanthamoeba trophozoites were attached to the corneal stromal nerves in five eyes. Conclusion: These findings suggest that white light IVCM can identify consistent corneal findings, particularly spatial changes in the corneal nerves, in cases of early-stage AK with RK.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis

Hung

Liu

et al. 2020

Indian J Ophthalmol

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“…Clinical features of AK are similar to other types of keratitis, such as fungal and herpes simplex virus infections. Although confocal microscopy is a noninvasive technique [1], the images of the cysts were atypical in some of the early-stage cases [22]. The microbiological examination of corneal scrapings by microscopy is easy, fast and efficient.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba keratitis related to contact lens use in a tertiary hospital in China

Wang

et al. 2019

BMC Ophthalmol

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Background To report the clinical and microbiological features of Acanthamoeba keratitis (AK) related to contact lens use in a tertiary hospital in China. Methods In this retrospective study, the medical results of 61 cases of AK related to contact lens use from January 2000 to December 2017 were reviewed. The data included patients’ demographics, lens type, history, risk factors, disease stages, corneal scraping and culture reports, and treatments. Moreover, genotypic identification of some of the isolates was carried out with a PCR assay and sequence analysis of the 18S ribosomal DNA gene. Results There were 64 eyes included in the study. A total of 32.8% of the patients wore soft contact lenses, and 67.2% of patients used overnight orthokeratology. In the cases (20 eyes) in the early stage, 65% (13 eyes) had positive results according to Giemsa-stained smears, and 0.9% sodium chloride (NaCl) wet mounts revealed trophozoites in 7 eyes (35%). Six eyes (30%) were diagnosed by confocal microscopy combined with clinical signs. In the orthokeratology patients, 87.8% (36/41) rinsed their lenses and/or cases with tap water; 55% of soft-lens wearers wore their lenses while showering. The genotype of 9 isolates was determined, and all the strains belonged to genotype T4. In the orthokeratology group, the number of patients who required therapeutic penetrating keratoplasty after 2005 was less than that before 2005 (chi-square test, χ2 = 4.209, P = 0.04). Conclusions More than two-thirds of the cases were associated with orthokeratology. Examinations with Giemsa-stained smears, 0.9% NaCl wet mounts and confocal microscopy should be performed for patients who are highly suspected of having early-stage AK to help with early diagnosis. In the orthokeratology group, the rate of therapeutic keratoplasty after 2005 was less than that before 2005.

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“…Clinical features of AK are similar to other keratitis sometimes, such as fungal and herpes simplex virus. Although confocal microscopy is a noninvasive technique [1] , the images of cysts were atypical in some cases of early stage [22] . Microbiological testing of corneal scrapings by microscopy is easy, fast and efficient.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba keratitis related to contact lens use in a tertiary hospital in China

Wang

et al. 2019

Preprint

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Background: To report the clinical and microbiological features of Acanthamoeba keratitis (AK) related to contact lens use in a tertiary hospital in China.Methods: In this retrospective study, the medical results of 61 cases of AK related to contact lens use from January 2000 to December 2017 were reviewed. The data included patients' demographics, lens type, history, risk factors, disease stages, corneal scraping and culture reports, and treatments.Moreover, genotypic identification of some of the isolates was carried out with a PCR assay and sequence analysis of the 18S ribosomal DNA gene.Results: There were 64 eyes included in the study. A total of 32.8% of the patients wore soft contact lenses, and 67.2% of patients used overnight orthokeratology. In the cases (20 eyes) in the early stage, 65% (13 eyes) had positive results according to Giemsa-stained smears, and 0.9% sodium chloride (NaCl) wet mounts revealed trophozoites in 7 eyes (35%). Six eyes (30%) were diagnosed by confocal microscopy combined with clinical signs. In the orthokeratology patients, 87.8% (36/41)

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In Vivo Laser Confocal Microscopy Findings of Radial Keratoneuritis in Patients with Early Stage Acanthamoeba Keratitis

Cited by 21 publications

References 22 publications

Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis

Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis

Acanthamoeba keratitis related to contact lens use in a tertiary hospital in China

Acanthamoeba keratitis related to contact lens use in a tertiary hospital in China

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