Diagnostic traps based on nomenclature of inflammatory changes in corneal confocal microscopy in vivo

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Abstract

Purpose

To present possible misdiagnosis of infectious keratitis in corneal confocal microscopy in vivo images based on typically used nomenclature.

Methods

Retrospective analysis of in vivo confocal microscopy images from 155 patients with different diagnosis. 63 cases were diagnosed in confocal microscopy as various infectious inflammations and confirmed microbiologically or based on treatment response. 25 of them were recognized as bacterial, 25 as viral, 11 as fungeal and 2 as Acanthoamebal keratitis. For each type of inflammation we selected “key words” typically used for describing characteristic corneal changes. In next step we analyzed other, non-inflammatory cases and selected images which could be described with nomenclature using typically for inflammatory changes describing (for example “cyst”, “fibers”, “round cells infiltration”, “dendritic/Langerhans cells presence”, etc.).

Results

From 92 non-inflammatory cases, 35 could be described with inflammatory “key words”. These cases represented 14 different pathologies: Cogan and Messmann dystrophy, stroma fibrosis, corneal transplant rejection, in-growth epithelial syndrome, crystal and vortex kerathopathy, after LASIK and after PRK changes, neurotrophic ulcer, superficial nerves outgrowth, diffuse anterior lamellar inflammation after LASEK, ichtyosis and Thygesson inflammation.

Conclusion

Diagnostic process using confocal microscopy examination cannot be based just on algorithmic analysis of corneal images. For reliable diagnosis microscopy images should be compared with clinical state and anamnesis.

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