Clinical Trial Summary
Infectious keratitis is a significant cause of partial vision loss and blindness and places a
large burden on eye care professionals. One of the main challenges for the ophthalmologist
when presented with a case of suspected microbial keratitis is the determination of the
subtype of keratitis. It must be determined whether the origin of the infection is bacterial,
viral, fungal, or parasitic, in order to prescribe a correct, effective treatment aimed at
the causative pathogen. In daily practice this can be challenging, and general treatments
with antibiotics are prescribed. Some cases then experiences deterioration, resulting in more
patients visits and further rounds of invasive treatments and progressive vision
deterioration.
This project is designed to break this cycle of nonspecific diagnosis, suboptimal treatment,
and progressive worsening of vision with increased interventions. New, advanced diagnostics
will be brought into the clinic to provide additional information which, if our hypothesis is
correct, will result in more rapid and accurate diagnosis of the keratitis subtype. This will
translate into earlier administration of a more targeted treatment, avoiding the repeated
round of non-targeted treatment and progressive worsening of the patient's vision. This can
directly reduce to number of clinic visits and specialist time required for treatment and
follow-up of keratitis, knowledge of how the eye responds to various microbes by initiating a
specific cascade of molecular inflammatory signals and changes in protein expression in the
tear film.
Using in vivo confocal microscopy (IVCM) we will document the cellular status of the cornea
and identify microbes infecting the cornea in real-time. Secondly, tear samples will be
obtained from patients with keratitis to evaluate and quantify the molecular cytokine
signatures associated with specific microbial species, confirmed by microbiological culture.
We will for the first time develop cytokine profiles for the various types of infection,
identifying diagnostic cytokines which in the longer term can lead to development of rapid
point-of-care biomarker diagnostics.
The project aims are translated into the following hypotheses:
H1: In vivo confocal microscopy imaging features detect microbial keratitis consistent with
clinical assessment and outcome at a greater frequency than microbiological culture results.
H2: Cytokine profiles (or a subset of molecules) in the eye are specific for viral,
bacterial, fungal, or amoebic keratitis; and H3: A combination of in vivo confocal microscopy
and molecular profiling of the tear film can yield a specific keratitis diagnosis closely
matching the clinical progression and outcome of keratitis.
