In Vivo Quantification of Bacterial Keratitis with Optical Coherence Tomography
To quantify the human corneal inflammatory response in treated bacterial keratitis with long-wavelength anterior segment optical coherence tomography (AS-OCT).
Patients with clinically suspected bacterial keratitis were recruited from the corneal service at Southampton Eye Unit, UK. Patients underwent AS-OCT and slit-lamp examination on presentation (day 0) and days 3, 7, and 14 of treatment. Corneal thickness (CT) in the infiltrated area, infiltrate thickness (IT), and infiltrate width (IW) were measured on high-resolution AS-OCT scans. Mean values for each day and rates of change for each interval were calculated and compared (one-way ANOVA, paired t-test).
Twenty-six eyes of 26 patients were recruited. Mean CT and IT on presentation were 905 μm and 388 μm, respectively. On days 3, 7, and 14, CT and IT decreased to 753 μm and 320 μm (P < 0.01), 678 μm and 296 μm (P < 0.01), and 584 μm and 207 μm (P < 0.01), respectively. Mean IW, 1498 μm on presentation, did not change during treatment (P > 0.30). Mean daily rate of CT reduction was faster in the early (days 0-3) compared to late (days 7-14) phase (4.49% vs. 1.33%, P = 0.006). Mean daily rate of IT reduction was no different in early, middle, and late phases (5.41% vs. 1.19% vs. 3.38%, P > 0.01). In the late phase, IT decreased faster than CT (3.38% vs. 1.33%, P = 0.003).
CT and IT decreased significantly by day 3 in resolving bacterial keratitis. The rapid early phase reduction in IT and CT was followed by rapid late phase IT reduction. This study demonstrates that serial AS-OCT examination can be used to monitor in vivo the clinical course of inflammatory disease.
Available from: Darlene Miller
- "Only recently, OCT has been used for imaging the anterior segment and the cornea in anterior chamber biometry , anterior segment tumors , and corneal refractive surgery . Several valuable studies of infectious keratitis by OCT have emerged; however, these studies used TD-OCT with resolutions of 18 microns, significantly lower than the 3 micron resolution of the new generations of SD-OCT [18,19]. "
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ABSTRACT: The aim of this study was to develop and characterize a new contact lens-associated fungal keratitis rat model and to assess the ability of non-invasive spectral-domain optical coherence tomography (SD-OCT) to detect pathological changes in vivo in fungal keratitis.
We used SD-OCT to image and measure the cornea of Sprague Dawley rats. Fusarium infection was initiated in the rat eye by fitting Fusarium solani-soaked contact lenses on the experimental eye, while the control animals received contact lenses soaked in sterile saline. The fungal infection was monitored with periodic slit-lamp examination and in vivo SD-OCT imaging of the rat eye, and confirmed by histology, counting of viable fungi in the infected rat cornea, and PCR with specific primers for Fusarium sp.
We imaged and measured the rat cornea with SD-OCT. Custom-made contact lenses were developed based on the OCT measurements. Incubation of contact lenses in a F. solani suspension resulted in biofilm formation. We induced contact lens-associated Fusarium keratitis by fitting the rat eyes for 4 h with the Fusarium-contaminated contact lenses. The SD-OCT images of the cornea correlated well with the slit-lamp and histopathological results and clearly defined clinical signs of infection, namely, increased corneal thickening, loss of epithelial continuity, hyper-reflective areas representing infiltrates, and endothelial plaques characteristic of fungal infection. Moreover, in three cases, SD-OCT detected the infection without any clear findings on slit-lamp examination. Infection was confirmed with histological fungal staining, PCR, and microbiological culture positivity.
We developed a highly reproducible rat contact lens model and successfully induced contact lens-associated Fusarium keratitis in this model. The clinical presentation of contact lens-associated Fusarium keratitis in the rat model is similar to the human condition. SD-OCT is a valuable tool that non-invasively revealed characteristic signs of the fungal infection and could provide sensitive, objective monitoring in fungal keratitis.
Available from: Koray Gumus
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ABSTRACT: To obtain images of anterior and posterior segments of the eye using a slit-lamp (SL)/spectral domain (SD) optical coherence tomography (OCT) integrated system designed for the human eye, in the cat, dog, minipig and monkey.
One healthy adult monkey, one healthy adult minipig, one healthy adult dog, one healthy adult cat, and three cats and four dogs affected by corneal or retinal diseases.
A SL SCAN-1 SD-OCT, which is a slit-lamp SL-D7 that contains an integrated OCT module and a fundus viewer, was used to generate OCT images (512-2048), while simultaneously taking 'en-face' slit-lamp images (efSL). OCT images were obtained under sedation or anesthesia. These images were compared to histological retinal sections obtained from a monkey, a minipig, a dog, and a cat.
'en-face' slit-lamp images and OCT images of the ocular tissues were obtained allowing for the identification of different corneal and retinal layers in all animal species. Measurements of the total retinal thickness (TRT) from the inner limiting membrane to the retinal pigment epithelium were performed in various regions throughout the retina. Reduction in TRT was consistent with clinical features of retinal degeneration identified in dogs and cats.
This noninvasive procedure is useful for both experimental and clinical assessments of ocular tissue damage. Images of anterior and posterior segments are readily obtained under routine clinical conditions. Future studies are warranted to establish normal OCT data in our patients with this new instrument.
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