[Inverted In Vitro Confocal Microscopy in Mycotic Keratitis with Corneal Endothelial Epithelial Decompensation].

Abstract:

:The sensitivity of confocal microscopy ranges between 80 and 90% and thus lies above the sensitivity of pathogen identification by microbiological culture. Typically, in vivo confocal microscopy enables us to diagnose mycotic keratitis non-invasively and atraumatically on the day of admission. Herein we present a patient with an ulcer on a corneal graft, pronounced corneal endothelial epithelial decompensation and a retrocorneal fungal adhesion after repeat-keratoplasty 5 years ago - due to chronic graft rejection after keratoplasty for Fuchs endothelial corneal dystrophy. Clinically there was a suspicion of fungal keratitis. Conventional en face confocal microscopy, however, did not detect hyphae. Due to the pronounced corneal endothelial epithelial decompensation, we were able to detect the fungal hyphae only after repeat penetrating keratoplasty by means of inverted in vitro confocal microscopy on the day of surgery. Histology confirmed the diagnosis of keratomycosis. :Die Sensitivität der konfokalen Mikroskopie liegt zwischen 80 und 90% und damit über der Sensitivität der Erregeridentifizierung mittels Kultur. Typischerweise kann mittels in vivo konfokaler Mikroskopie bereits am Tag der Aufnahme eine mykotische Keratitis nicht invasiv und atraumatisch diagnostiziert werden. Wir stellen eine Patientin vor mit einem Hornhautulkus im Bereich des Transplantats, ausgeprägter Hornhaut-Endothel-Epithel-Dekompensation (HEED) und retrokornealen Pilzzapfen bei Zustand nach Re-Keratoplastik vor 5 Jahren bei chronischer Transplantatabstoßungsreaktion wegen HEED bei Fuchsʼscher Endotheldystrophie. Klinisch bestand der Verdacht auf eine mykotische Keratitis. Die konventionelle en face konfokale Mikroskopie zeigte initial keine Pilzhyphen. Aufgrund des ausgeprägten Hornhautödems konnten wir erst nach einer Re-Re-Keratoplastik mittels der invertierten in vitro konfokalen Mikroskopie die Pilzhyphen im hinteren Hornhautstroma am Operationstag nachweisen. Die Histologie bestätigte die Diagnose der Keratomykose.

journal_name

Klin Monbl Augenheilkd

authors

Daas L,Seitz B,Zimpfer A,Bischoff M,Viestenz A

doi

10.1055/a-0983-1752

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1457-1460

issue

12

eissn

0023-2165

issn

1439-3999

journal_volume

236

pub_type

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