Antifungal Chemotherapy For Fungal Keratitis Guided By In Vivo Laser Confocal Microscopy

BackgroundTo evaluate antifungal chemotherapy in patients with fungal keratitis guided by laser confocal microscopy.MethodsA total of 65 patients(65 eyes) with fungal keratitis were enrolled in this study. Laser confocal microscopy was performed 1w、2w、4w and 1w after discontinuation of the treatment after topical antifungal chemotherapy. Hyphal density and morphology,composition of inflammatory cells,and appearance of corneal stromal cells at the central and peripheral corneal lesions were recorded. Antifungal therapy discontinued at 2 week after hyphae and inflammatory cells could not be detected,and affected corneal stromal cells became visible.ResultsSuccessful outcomes were achieved in 60 patients. By confocal microscopy,we observed the gradual decrease of hyphae-positive sites and hyphal density during the chemotherapy.After 2weeks of treatment,in 22 cases ulcers healed up and epithelium revealed bubble between the cells;A numerous dendritic cells presented in the basal epithelium layer; no hyphae and inflammatory cells were found.After 4 weeks of treatment,all corneal ulcers healed up;hyphae hyphae was completely disappeared; inflammatory cells and dendritic cells gradually abated with disease regression in 32 patients,but a few trifle hyphae still could be found in 6 patients.The inflammatory cells reduced in number and heterogeneity,while corneal stromal cells recovered. The antifungal drugs were tapered according to the changes in hyphae,inflammatory cells,and corneal stromal cells. There was no fungal recurrence during the 2month follow-up period. The other 5 patients had deteriorated infection within 1 week of antifungal therapy, and therefore were subjected to corneal transplantation.Conclusions In vivo confocal microscopy appears to be an effective approach to guide antifungal chemotherapy. It allows comprehensive evaluation of hyphae,inflammatory cells, corneal epithelial healing time and corneal stromal cells in real time,and provides valuable and objective information required in selecting and adjusting therapeutic regimens for the treatment of fungal keratitis.