Diagnostic accuracy of microbial keratitis with in vivo scanning laser confocal microscopy

AIMS: To determine the accuracy of diagnosing microbial keratitis by masked medical and non-medical observers using the Heidelberg Retina Tomograph II/Rostock Cornea Module in vivo confocal microscope.

METHODS: Confocal images were selected for 62 eyes with culture- or biopsy-proven infections. The cases comprised 26 Acanthamoeba, 12 fungus, three Microsporidia, two Nocardia and 19 bacterial infections (controls). The reference standard for comparison was a positive tissue diagnosis. These images were assessed on two separate occasions by four observers who were masked to the tissue diagnosis. Diagnostic accuracy indices, kappa statistic and percentage agreement values were calculated. The Spearman correlation coefficient (r(s)) was calculated for the number of correct diagnoses versus duration of disease.

RESULTS: The highest sensitivity and specificity values were 55.8% and 84.2%, respectively, and the lowest sensitivity and specificity values were 27.9% and 42.1%, respectively. The highest positive and lowest negative likelihood ratios were 2.94 and 0.59, respectively. Agreement values were: fair to moderate (kappa 0.22-0.44) for reference standard versus observer diagnosis, moderate to good in intraobserver variability (repeatability, kappa 0.56-0.88) and poor to moderate in interobserver variability (reproducibility, kappa 0.15-0.47). The correct diagnosis was associated with duration of disease for Acanthamoeba keratitis (r(s)=0.60, p=0.001).

CONCLUSIONS: The diagnostic accuracy of microbial keratitis by confocal microscopy is dependent on observer experience. Intraobserver repeatability was better than interobserver reproducibility. Difficulty in distinguishing host cells from pathogenic organisms limits the value of confocal microscopy as a stand-alone tool in diagnosing microbial keratitis.

Errataetall:

CommentIn: Br J Ophthalmol. 2010 Aug;94(8):961-2. - PMID 20679086

Medienart:

E-Artikel

Erscheinungsjahr:

2010

Erschienen:

2010

Enthalten in:

Zur Gesamtaufnahme - volume:94

Enthalten in:

The British journal of ophthalmology - 94(2010), 8 vom: 22. Aug., Seite 982-7

Sprache:

Englisch

Beteiligte Personen:

Hau, Scott C [VerfasserIn]
Dart, John K G [VerfasserIn]
Vesaluoma, Minna [VerfasserIn]
Parmar, Dipak N [VerfasserIn]
Claerhout, Ilse [VerfasserIn]
Bibi, Kanom [VerfasserIn]
Larkin, Daniel F P [VerfasserIn]

Links:

Volltext

Themen:

Culture Media
Evaluation Study
Journal Article

Anmerkungen:

Date Completed 19.08.2010

Date Revised 10.12.2019

published: Print-Electronic

CommentIn: Br J Ophthalmol. 2010 Aug;94(8):961-2. - PMID 20679086

Citation Status MEDLINE

doi:

10.1136/bjo.2009.175083

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM198728816