Purpose: 

Endothelial plaque is an important sign of fungal keratitis and is related to diagnosis, surgical indications, and prognosis. However, bacterial keratitis sometimes involves fibrin formation on the back corneal surface, similar to endothelial plaques. Because corneal infiltration interferes with precise observation of the posterior corneal plaque, distinguishing pathogens with a slitlamp is difficult. We hope to assist clinicians in early diagnosis and timely treatment by observing the connection state of endothelial plaques and the corneal endothelium through anterior segment optical coherence tomography (AS-OCT) and the different forms of endothelial plaques in infectious keratopathy through in vivo confocal microscopy (IVCM).

Methods: 

We analyzed 52 patients in the Eye Hospital of the First Affiliated Hospital of Harbin Medical University who were clearly diagnosed with fungal or bacterial keratitis with endothelial plaques. All patients underwent AS-OCT and IVCM on admission.

Results: 

According to the smear, IVCM, or fungal and bacterial culture results, the patients were diagnosed with fungal (28 patients) or bacterial keratitis (24 patients). AS-OCT in 25 patients diagnosed with fungal keratitis revealed that the corneal endothelium–endothelial plaque boundary was unclear and wavy, and 24 patients had unclear cell boundaries and a large number of compactly distributed inflammatory cells in the endothelial layer according to IVCM. AS-OCT in 23 patients diagnosed with bacterial keratitis revealed clear corneal endothelium–endothelial plaque boundaries, and insufficient endothelial cell boundaries with a large number of visible and scattered inflammatory cell structures were observed through IVCM in 22 patients.

Conclusions: 

Corneal endothelial plaque detection by AS-OCT and IVCM can be used for early diagnosis of infectious keratitis.

中文翻译：

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眼前节光学相干断层扫描和活体共聚焦显微镜对真菌性和细菌性角膜炎角膜内皮斑块的临床观察

目的： 

内皮斑块是真菌性角膜炎的重要体征，与诊断、手术指征和预后相关。然而，细菌性角膜炎有时涉及角膜后表面的纤维蛋白形成，类似于内皮斑块。由于角膜浸润会干扰对后角膜斑块的精确观察，因此用裂隙灯区分病原体很困难。我们希望通过眼前段光学相干断层扫描（AS-OCT）观察内皮斑块与角膜内皮的连接状态以及通过活体共聚焦显微镜观察感染性角膜病中不同形态的内皮斑块，以帮助临床医生早期诊断和及时治疗。 IVCM）。

方法： 

我们分析了哈尔滨医科大学第一附属医院眼科医院明确诊断为伴有内皮斑块的真菌或细菌性角膜炎的52例患者。所有患者入院时均接受 AS-OCT 和 IVCM。

结果： 

根据涂片、IVCM或真菌和细菌培养结果，患者被诊断为真菌性（28例）或细菌性角膜炎（24例）。25例确诊为真菌性角膜炎的患者AS-OCT显示角膜内皮-内皮斑块边界不清、呈波状，IVCM显示24例患者细胞边界不清，内皮层有大量致密分布的炎症细胞。23例细菌性角膜炎患者的AS-OCT显示清晰的角膜内皮-内皮斑块边界，22例IVCM观察到内皮细胞边界不充分，可见大量可见且散在的炎症细胞结构。

结论： 

AS-OCT和IVCM检测角膜内皮斑块可用于感染性角膜炎的早期诊断。