In vivo imaging of corneal inflammation: new tools for clinical practice and research

Abstract

Purpose: Infectious and inflammatory corneal diseases are a major cause of blindness. To date, assessment of corneal inflammation, has only been possible by slit-lamp biomicroscopy. The purpose of this study is to review the current state of imaging technologies enabling in vivo imaging of inflammation in the cornea.

Methods: Literature review of peer-reviewed articles on in vivo imaging modalities.

Results: Current means of diagnosis and treatment follow-up for immune and infectious keratitis are limited to slit-lamp biomicroscopy. Several modalities are currently emerging, allowing for in vivo imaging of corneal inflammation, including in vivo confocal microscopy, anterior segment optical coherence tomography, and intravital multiphoton microscopy.

Conclusion: Several in vivo imaging technologies are currently evolving, allowing for objective assessment of corneal inflammation and treatment response.

FIGURE 1

(A, B) In vivo confocal image of a patient with acute fungal keratitis, demonstrating a significant influx of leukocytes. (C) In vivo confocal image of a patient with chronic Acanthamoeba keratitis, demonstating a significant increase in dendritic Langerhans cells in the corneal epithelium, with extensive dendritic processes. (D) Corneal nerves and immunce cells depicted with in vivo confocal image in a patient with viral keratitis.

FIGURE 2

Slit lamp (left) and OCT image (right) of a patient with fungal keratitis, demonstrating inflammation in the anterior stroma.

FIGURE 3

Two Photon Microscopy picture of the cornea in a Major Histocompatibility Class II (MHCII)-GFP mouse. MHC II-positive antigen presenting cells appear green and stromal collagen appears in blue (second harmonic generation). Peripheral (lower right) and central (upper left) cornea are visualized.