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Purpose <p>To evaluate the anterior segment optical coherence tomography (AS-OCT) features of infectious keratitis (IK) and assess their correlation with clinical and microbiological findings.</p> Methods <p>This cross-sectional study included 58 patients with culture-positive corneal abscesses, complete medical records, and high-quality AS-OCT imaging. Independent clinical and AS-OCT assessments were conducted to identify pathogen-specific features and evaluate their diagnostic sensitivity.</p> Results <p>Distinct AS-OCT patterns were identified for each pathogen. Gram-positive bacterial keratitis was associated with stromal edema (<i>p</i> 0.006; OR = 20.6) and Descemet folds (<i>p</i> 0.01; OR = 4.83), whereas Gram-negative keratitis exhibited diffuse infiltrates (<i>p</i> &lt; 0.001; OR = 14.286) and stromal thinning (<i>p</i> &lt; 0.001; OR = 98.9). Fungal keratitis was characterized by stromal cystic spaces (<i>p</i> &lt; 0.001; OR = 82.1), stromal thinning (<i>p</i> 0.042; OR = 4.71) and endothelial plaques with indistinct corneal boundaries (<i>p</i> &lt; 0.001; OR = 207). Combining AS-OCT with clinical findings enhanced diagnostic sensitivity to 75% for Gram-positive bacterial keratitis, 66.7% for Gram-negative keratitis, and 100% for fungal keratitis.</p> Conclusions <p>AS-OCT provides key pathogen-specific features in IK, improving diagnostic accuracy, particularly in cases with inconclusive microbiological results. While AS-OCT should not replace microbiological testing, its integration into clinical protocols can refine diagnostic strategies. Future applications of artificial intelligence could further optimize early pathogen identification and treatment outcomes.</p>

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Predicting the causative agent in microbial keratitis: the role of anterior segment optical coherence tomography—a cross-sectional analysis

  • 期刊论文

  • 发表日期：

    2025年4月7日

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  • Sara Ben Addou Idrissi,
  • Ahmed Bennis,
  • Hassan Moutei,
  • Fouad Chraibi,
  • Meriem Abdellaoui,
  • Idriss Benatiya Andaloussi

摘要

Purpose

To evaluate the anterior segment optical coherence tomography (AS-OCT) features of infectious keratitis (IK) and assess their correlation with clinical and microbiological findings.

Methods

This cross-sectional study included 58 patients with culture-positive corneal abscesses, complete medical records, and high-quality AS-OCT imaging. Independent clinical and AS-OCT assessments were conducted to identify pathogen-specific features and evaluate their diagnostic sensitivity.

Results

Distinct AS-OCT patterns were identified for each pathogen. Gram-positive bacterial keratitis was associated with stromal edema (p 0.006; OR = 20.6) and Descemet folds (p 0.01; OR = 4.83), whereas Gram-negative keratitis exhibited diffuse infiltrates (p < 0.001; OR = 14.286) and stromal thinning (p < 0.001; OR = 98.9). Fungal keratitis was characterized by stromal cystic spaces (p < 0.001; OR = 82.1), stromal thinning (p 0.042; OR = 4.71) and endothelial plaques with indistinct corneal boundaries (p < 0.001; OR = 207). Combining AS-OCT with clinical findings enhanced diagnostic sensitivity to 75% for Gram-positive bacterial keratitis, 66.7% for Gram-negative keratitis, and 100% for fungal keratitis.

Conclusions

AS-OCT provides key pathogen-specific features in IK, improving diagnostic accuracy, particularly in cases with inconclusive microbiological results. While AS-OCT should not replace microbiological testing, its integration into clinical protocols can refine diagnostic strategies. Future applications of artificial intelligence could further optimize early pathogen identification and treatment outcomes.