In vivo confocal microscopy and anterior segment optical coherence tomography in a case of alternaria keratitis

PURPOSE: To report a case of Alternaria alternata keratitis analyzed with in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (OCT). METHODS: A 68-year-old man with unilateral keratitis was evaluated using IVCM (Heidelberg Retina Tomograph II; Heidelberg, Germany) and anterior segment OCT (Visante OCT; Carl Zeiss Meditec, Dublin, CA). RESULTS: IVCM demonstrated the presence of small, round, hyperreflective cells surrounded by hyporeflective irregular areas and highly reflective dendritic shaped cells at the level of the epithelium. Stromal examination revealed many hypereflective filamentous structures, and some hyporeflective perpendicular lines and hyperreflective oval bodies were clearly visible along the filaments. Anterior segment OCT examination demonstrated a thickened cornea due to diffuse edema and an irregular corneal surface corresponding to the ulcer. There were hyperreflective areas beneath the epithelium representing the infiltrate. Microbiological examination of corneal scrapings demonstrated the presence of Alternaria alternata. After 1 month of antifungal treatment, IVCM demonstrated a significant reduction of the inflammatory cells and a hyperreflective scar-like tissue. Branching hyphal infiltrates were no longer present. OCT also documented the healing process and the complete recovery of the central and peripheral stromal thickness. CONCLUSIONS: IVCM and anterior segment OCT could be useful for the early diagnosis and treatment of fungal keratitis.