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The use of in vivo confocal microscopy in fungal keratitis – Progress and challenges
The Ocular Surface ( IF 6.4 ) Pub Date : 2022-03-10 , DOI: 10.1016/j.jtos.2022.03.002
Ingvild M Bakken 1 , Catherine J Jackson 2 , Tor P Utheim 3 , Edoardo Villani 4 , Pedram Hamrah 5 , Ahmad Kheirkhah 6 , Esben Nielsen 7 , Scott Hau 8 , Neil S Lagali 9
Affiliation  

Fungal keratitis (FK) is a serious and sight-threatening corneal infection with global reach. The need for prompt diagnosis is paramount, as a delay in initiation of treatment could lead to irreversible vision loss. Current “gold standard” diagnostic methods, namely corneal smear and culture, have limitations due to diagnostic insensitivity and their time-consuming nature. PCR is a newer, complementary method used in the diagnosis of fungal keratitis, whose results are also sample-dependent. In vivo confocal microscopy (IVCM) is a promising complementary diagnostic method of increasing importance as it allows non-invasive real-time direct visualization of potential fungal pathogens and manifesting infection directly in the patient's cornea. In numerous articles and case reports, FK diagnosis by IVCM has been evaluated, and different features, approaches, sensitivity/specificity, and limitations have been noted. Here, we provide an up-to-date, comprehensive review of the current literature and present the authors' combined recommendations for fungal identification in IVCM images, while also looking to the future of FK assessment by IVCM using artificial intelligence methods.



中文翻译:

体内共聚焦显微镜在真菌性角膜炎中的应用——进展与挑战

真菌性角膜炎 (FK) 是一种严重且威胁视力的角膜感染,影响全球。及时诊断至关重要,因为延迟开始治疗可能导致不可逆转的视力丧失。当前的“金标准”诊断方法,即角膜涂片和培养,由于诊断不敏感和耗时的性质而具有局限性。PCR 是用于诊断真菌性角膜炎的一种较新的补充方法,其结果也取决于样本。体内共聚焦显微镜 (IVCM) 是一种有前途的补充诊断方法,其重要性日益增加,因为它允许对潜在的真菌病原体进行无创实时直接可视化,并直接在患者的角膜中显示感染。在许多文章和病例报告中,IVCM 对 FK 诊断进行了评估,并指出了不同的特征、方法、敏感性/特异性和局限性。在这里,我们提供了对当前文献的最新、全面的回顾,并提出了作者对 IVCM 图像中真菌鉴定的综合建议,同时也展望了 IVCM 使用人工智能方法进行 FK 评估的未来。

更新日期:2022-03-10
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