The Application Of Confocal Scanning Laser Microscopy In The Diagnosis And Clinical Course Of Acanthamoeba Keratitis:(Case Reports)

ObjectivesTo evaluate the role of in vivo laser scanning confocal microscopy(Heidelberg Retina Tomograph3, Rostock Cornea Module,HRT3-RCM) in the diagnosis of Acanthamoeba keratitis, a comparative analysis compared with traditional treatment approaches, the advantages and disadvantages of the method to explore the significance of treatment means in the course of treatment as a follow up study.MethodsFive eyes of five patients with AK seen at QILU Hospital were studied,compared patient confocal microscope (model) examination and corneal scraping bacteria, fungi, and amoeba microscopic examination and culture. And all patients were routinely examined by Slit-lamp microscopy.In accordance with the time of diagnosis of patients admitted to hospital performance, divided into patients with early and late patients, to explore the the importance of the confocal microscope to diagnosis of Ak in early stage and the follow upof the treatment process.ResultsAll patients had various degrees of conjunctival injection,corneal edema,stromal opacity with radial keratoneuritis with Slit-lamp microscopy examination.One patient had the typical corneal stromal ring infiltration.Corneal scraping did not check to see amoebic cysts, and fungal hyphae, fungal, bacterial culture have no positive cases. Confocal Acanthamoeba cysts in the corneal stroma within150μm, four cases of patients only find one cyst in there cornea,The cysts are round or oval hyperechoic structure, double wall, the size is25～150μm, the kernel shape round. In the course of the medical treatment, the shape and size had changed in two patient.In the medication process,12Weeks one Patients showed the cyst to disappear with confocal microscopy examination.ConclusionConfocal microscopy is a rapid and noninvasive method for real-time biopsy, with high clarity and resolution. The advantages of the exact positioning of the depth, time dynamic observation, longitudinal tomography can be used as Acanthamoeba corneal inflammatory etiological diagnosis and treatment follow-up observation.It has an important means of auxiliary examination. HRT3-RCM could provide an early and clear diagnosis of Acanthamoeba keratitis. In the course of the treatment in vivo confocal microscopy demonstrate an end-point for treatment saving the patient from additional invasive diagnostic procedures and unneeded exposure to long term topical or systemic medications.