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 Table of Contents  
OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 445

Fungal corneal ulcer: Through the eyes of a Scheimpflug camera


1 Medical Officer, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Medical Officer, Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Head of the Department of Cataract and Refractive Surgery, Eye Hospital Private Limited, Trichy, Tamil Nadu, India
4 Chief Medical Officer, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Prasanna V Ramesh
Mahathma Eye Hospital Private Limited, No 6, Tennur, Seshapuram, Trichy - 620 017,Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3140_20

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How to cite this article:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Fungal corneal ulcer: Through the eyes of a Scheimpflug camera. Indian J Ophthalmol Case Rep 2021;1:445

How to cite this URL:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Fungal corneal ulcer: Through the eyes of a Scheimpflug camera. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 28];1:445. Available from: https://www.ijoreports.in/text.asp?2021/1/3/445/320109



A 35-year-old woman presented with pain and redness in the left eye following injury with vegetative matter and was diagnosed with fungal corneal ulcer [Figure 1]a. Anterior segment optical coherence tomography (AS-OCT) revealed hyper-reflectivity of the corneal stroma with disruption of the epithelium [Figure 1]b.[1] Scheimpflug imaging system revealed a similar hyper-reflectivity in the stromal region [Figure 1]c, and a dark zone in the similar area [Figure 1]d when the background color was inverted for better contrast. Scheimpflug system appears to be a promising tool for evaluation of infective keratitis as it helps in quantitative dimensional analysis of the extent of the ulcer and infiltrate separately with additional depth analysis.
Figure 1: (a) Slit-lamp photography of fungal corneal ulcer showing feathery margins and raised dry surface. (b) Anterior segment optical coherence tomography revealing hyper-reflectivity of the corneal stroma (red arrows) with disruption of corneal epithelium. (c and d) Scheimpflug imaging system showing hyper-reflectivity of stromal region (red arrow) and a dark highlighted zone in the same area (red arrow) with inversion of background color, respectively

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Though AS-OCT is another well-documented adjunct in monitoring fungal keratitis with various objective parameters such as corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width measurement, the posterior border of the cornea was not clearly visible in AS-OCT images in general, as proposed by Sharma et al., because of posterior shadowing.[2] Although with Scheimpflug imaging system 360-degree posterior corneal imaging can be performed with good-quality image acquisition and with the help of inverse color contrast for analysis, there is a better and precise yield of corneal ulcer's dimensions for examination with digital calipers.

In this scenario, it was concluded that the extent of corneal ulcer and its infiltrate [Figure 2]a was best visualized and measured in default Scheimpflug images, whereas the depth of the ulcer [Figure 2]b was best visualized and measured in inverse color Scheimpflug images. However, with only one case, no conclusions can be made. Ideally, a series of keratitis cases should be examined and a gold standard method of measuring the 'ulcer' and 'infiltrate' must be arrived. Also the possibility of optical blooming in Scheimpflug imaging, affecting the measurements with digital calipers should be anticipated while using the calipers.
Figure 2: (a) High magnification view of the Scheimpflug images revealing the extent of the corneal ulcer (2.24 mm) and infiltrate (3.33 mm). (b) High magnification view of the same Scheimpflug images in inverse color revealing the depth of the ulcer (0.23 mm)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Konstantopoulos A, Kuo J, Anderson D, Hossain P. Assessment of the use of anterior segment optical coherence tomography in microbial keratitis. Am J Ophthalmol 2008;146:534-42.  Back to cited text no. 1
    
2.
Sharma N, Singhal D, Maharana PK, Agarwal T, Sinha R, Satpathy G, et al. Spectral domain anterior segment optical coherence tomography in fungal keratitis. Cornea 2018;37:1388-94.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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