Confocal Microscopy In Atypical Microbial Keratitis- Pearls, Pitfalls, And Challenges

To explore the role of confocal microscopy across different clinical scenarios of atypical microbial keratitis.

Tertiary eye care centre

We report the confocal microscopy features of microbial keratitis 25 patients of fungal, acanthamoebal and bacterial etiology in an observational stusy.

We highlight the typical features as well the ambiguous features observed in culture-positive cases that can pose diagnostic dilemmas. In addition, we report the features on IVCM that may masquerade as pathological findings in the light of background inflammation, sub-basal nerve alterations, stromal edema, and enhanced extracellular matrix reflectivity. 

In vivo confocal microscopy is a useful tool for diagnosing microbial keratitis caused by fungi and acanthamoeba. Presence of ambiguous findings on IVCM images may pose a diagnostic challenge. Culture findings and clinical course of the infection may be valuable in revealing the causative agent in such cases.