Clinical Characteristics and In Vivo Confocal Microscopic Study in Candida Keratitis.

IF 2.6 3区医学 Q2 OPHTHALMOLOGY

Translational Vision Science & Technology Pub Date : 2025-01-02 DOI:10.1167/tvst.14.1.23

Yan Peng, Qiankun Chen, Yuan Wei, Leying Wang, Zijun Zhang, Zhenyu Wei, Jinding Pang, Bo Peng, Qingquan Shi, Zhiqun Wang, Yang Zhang, Kexin Chen, Xizhan Xu, Qingfeng Liang

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引用次数: 0

Abstract

Purpose: To clarify the clinical and imaging characteristics of Candida keratitis using in vivo confocal microscopy (IVCM) for improved early diagnosis and management.

Methods: A retrospective study of 40 patients with Candida keratitis at Beijing Tongren Hospital from January 2015 to December 2023 was conducted. Data included demographics, risk factors, clinical assessments, lab tests, and IVCM images. Ex vivo confocal microscopy and methylene blue staining of Candida colonies were also analyzed to complement the findings.

Results: Key risk factors identified were topical steroid use, intraocular surgery history, and systemic diseases. Common clinical signs included multifocal infiltration, cream-colored infiltration, and blurred boundary lesions. IVCM on 37 eyes (92.5%) consistently showed round, highly reflective Candida spores, and short rod-shaped spores in some cases. Spores exhibited two patterns: caviar-like clusters (51.4%) and sand-like dispersion (89.2%). Multifocal infiltration was significantly associated with a greater prevalence of clustered spores (75.0% vs. 33.3%; P < 0.05). Candida pseudo-hyphae appeared as beaded (91.7%) or lotus root-shaped (41.7%), highly reflective structures. These IVCM findings closely matched colony ex vivo confocal microscopy and light microscopy observations. After treatment, 45% of patients required surgery owing to minimal improvement in best-corrected visual acuity. Poor outcomes were linked to cream-colored infiltration, blurred lesions boundaries, hypopyon, high inflammatory cell density, and deep Candida infiltration (P < 0.05). Clustered spores suggested better outcomes, but lacked statistical significance (P > 0.05).

Conclusions: IVCM effectively identifies characteristic spores and pseudo-hyphae in Candida keratitis, facilitating early detection and timely management, particularly in cases with multifocal infiltration and blurred boundary lesions.

Translational relevance: IVCM works well for the early diagnosis of Candida keratitis, especially in cases of deep corneal stromal infiltration or corneal interface infection after corneal transplantation.

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念珠菌性角膜炎的临床特点及体内共聚焦显微镜研究。

目的：利用体内共聚焦显微镜（IVCM）明确念珠菌性角膜炎的临床和影像学特点，提高早期诊断和治疗水平。方法：对2015年1月至2023年12月北京同仁医院收治的40例念珠菌角膜炎患者进行回顾性研究。数据包括人口统计、危险因素、临床评估、实验室检查和IVCM图像。对假丝酵母菌落的离体共聚焦显微镜和亚甲基蓝染色也进行了分析，以补充研究结果。结果：确定的关键危险因素是局部使用类固醇，眼内手术史和全身性疾病。常见临床表现为多灶性浸润、米色浸润、病灶边界模糊。37只眼（92.5%）的IVCM一致显示圆形、高反射的念珠菌孢子，部分病例显示短杆状孢子。孢子呈鱼子酱状聚集（51.4%）和沙状分散（89.2%）。多灶浸润与聚集孢子的患病率显著相关(75.0% vs. 33.3%；P < 0.05)。假念珠菌菌丝呈串珠状（91.7%）或莲藕状（41.7%），呈高反射结构。这些IVCM结果与菌落离体共聚焦显微镜和光学显微镜观察结果密切匹配。治疗后，由于最佳矫正视力改善甚微，45%的患者需要手术。较差的预后与乳白色浸润、病灶边界模糊、低剂量、高炎症细胞密度和深度念珠菌浸润有关（P < 0.05）。孢子聚集的结果较好，但缺乏统计学意义（P < 0.05）。结论：IVCM能有效识别假丝酵母菌角膜炎的特征性孢子和假菌丝，有利于早期发现和及时处理，特别是对多灶浸润和病灶边界模糊的病例。翻译相关性：IVCM对假丝酵母角膜炎的早期诊断有很好的效果，特别是在角膜移植后角膜间质浸润或角膜界面感染的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational Vision Science & Technology Engineering-Biomedical Engineering

CiteScore

5.70

自引率

3.30%

发文量

346

审稿时长

25 weeks

期刊介绍： Translational Vision Science & Technology (TVST), an official journal of the Association for Research in Vision and Ophthalmology (ARVO), an international organization whose purpose is to advance research worldwide into understanding the visual system and preventing, treating and curing its disorders, is an online, open access, peer-reviewed journal emphasizing multidisciplinary research that bridges the gap between basic research and clinical care. A highly qualified and diverse group of Associate Editors and Editorial Board Members is led by Editor-in-Chief Marco Zarbin, MD, PhD, FARVO. The journal covers a broad spectrum of work, including but not limited to: Applications of stem cell technology for regenerative medicine, Development of new animal models of human diseases, Tissue bioengineering, Chemical engineering to improve virus-based gene delivery, Nanotechnology for drug delivery, Design and synthesis of artificial extracellular matrices, Development of a true microsurgical operating environment, Refining data analysis algorithms to improve in vivo imaging technology, Results of Phase 1 clinical trials, Reverse translational ("bedside to bench") research. TVST seeks manuscripts from scientists and clinicians with diverse backgrounds ranging from basic chemistry to ophthalmic surgery that will advance or change the way we understand and/or treat vision-threatening diseases. TVST encourages the use of color, multimedia, hyperlinks, program code and other digital enhancements.