In vivo confocal microscopy of the cornea: State of the art and the potential of artificial intelligence

In vivo confocal microscopy of the cornea: state of the art and the potential of artificial intelligence. Giulio Ferrari, MD PhD; Massimo De Micheli, MD. Laser confocal microscopy of the cornea (IVCM) allows in vivo, real time imaging of the corneal histology. All the corneal layers can be imaged, without need of contrast agents. While morphological characteristics of multiple corneal and systemic diseases have been described, the use of IVCM in the clinic is principally indicated to reach an early diagnosis of acanthamoeba and fungal keratitis. Significant limitations include the need of highly experienced examinators, and inability to diagnose bacterial keratitis. Moreover, reaching a correct diagnosis is more complex in advanced cases, where coexisting inflammation substantially reduces corneal transparency. Artificial intelligence represents an attractive tool to overcome, at least in part, these shortcomings and has potential to substantially increase the specificity and sensitivity of IVCM.