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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 190-191

Bilateral microsporidial stromal keratitis


Medical Research Foundation, College Road, Chennai, Tamil Nadu, India

Date of Submission30-Aug-2020
Date of Acceptance04-Dec-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Meena Lakshmipathy
Medical Research Foundation, College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2766_20

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  Abstract 


Keywords: Hansen's disease, microbial keratitis, microsporidia, microsporidial stromal keratitis


How to cite this article:
Harwani AA, Lakshmipathy M, Therese K L, Biswas J. Bilateral microsporidial stromal keratitis. Indian J Ophthalmol Case Rep 2021;1:190-1

How to cite this URL:
Harwani AA, Lakshmipathy M, Therese K L, Biswas J. Bilateral microsporidial stromal keratitis. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 29];1:190-1. Available from: https://www.ijoreports.in/text.asp?2021/1/2/190/312396




  Case Report Top


A 66-year-old male, who had Hansen's disease 15 years back, presented with a right eye (OD) corneal epithelial defect and whitish stromal infiltrate measuring 3 mm × 2 mm and 5.5 mm × 3.5 mm respectively, and left eye (OS) 2 mm whitish infiltrate with a minimal epithelial defect [Figure 1]a and [Figure 1]b. Both the eyes were pseudophakic and the ocular examination was otherwise normal. Corneal scrapping was inconclusive and the patient was treated as a bacterial keratitis, but with no response to the medical treatment repeat scraping was ordered with a request to specifically look for microsporidial spores, which came positive [Figure 1]c and [Figure 1]d. The patient was treated with propamidine isethionate 0.1% eye drops and polyhexamethylene biguanide (PHMB) 0.02% eye drops ten times a day each. The OS responded to topicals and completely healed within 3 months [Figure 2]a, while the OD remained the same, and hence OD therapeutic penetrating keratoplasty (TPK) was done. Histopathology of recipient corneal button confirmed microsporidia spores [Figure 2]b.
Figure 1: (a) Right eye at presentation with an epithelial defect, underlying anterior to mid stromal whitish infiltrate. (b) Left eye at presentation having whitish anterior stromal infiltrate with a minimal epithelial defect. (c) KOH + calcofluor white stain of corneal scrape showing round to oval 2-3 μm in size microsporidial spores (×20 magnification). (d) 1% Acid-fast stain of corneal scrape showing bright pinkish-red microsporidal spores (×20 magnification)

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Figure 2: (a) Left eye healed keratitis after 3 months showing a vascularized corneal scar. Congestion is due to toxic effects of PHMB and propamidine which resolved after stopping them. (b) Histopathology section of the corneal button of the right eye stained with trichrome stain showing bluish-purple microsporidial spores (×200 magnification). (c) Right eye at final visit showing failed graft with no recurrence

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The OD graft had failed over the time and the patient underwent OD optical penetrating keratoplasty elsewhere; and came for follow-up with the vision of 3/60 in the OD with mildly hazy graft [Figure 2]c and 6/24 in the OS with vascularized corneal opacity.


  Discussion Top


Microsporidial stromal keratitis poses a clinical challenge due to its resemblance with viral or other microbial keratitis cases and difficulty in diagnosis.[1],[2] As bilateral disease is rare, a probable predisposing factor in our case could be the past history of leprosy with eventual reduced corneal sensation. The laboratory diagnosis of microsporidia keratitis can be made through routine microscopy. Effectiveness of medical therapy with topical and oral antiprotozoal is inconclusive.[1],[3] However, in most of the stromal keratitis cases, TPK appears to be the best option available.[2] Lamellar keratoplasty has been tried but recurrence has been reported.[4],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vemuganti GK, Garg P, Sharma S, Joseph J, Gopinathan U, Singh S. Is microsporidial keratitis an emerging cause of stromal keratitis? A case series study. BMC Ophthalmol 2005;5:19.  Back to cited text no. 1
    
2.
Sabhapandit S, Murthy SI, Garg P, Korwar V, Vemuganti GK, Sharma S. Microsporidial stromal keratitis: Clinical features, unique diagnostic criteria, and treatment outcomes in a large case series. Cornea 2016;35:1569-74.  Back to cited text no. 2
    
3.
Loh RS, Chan CML, Ti SE, Lim L, Chan KS, Tan DTH. Emerging prevalence of microsporidial keratitis in Singapore: Epidemiology, clinical features, and management. Ophthalmology 2009;116:2348-53.  Back to cited text no. 3
    
4.
Font RL, Samaha AN, Keener MJ, Chevez-Barrios P, Goosey JD. Corneal microsporidiosis. Report of case, including electron microscopic observations. Ophthalmology 2000;107:1769-75.  Back to cited text no. 4
    
5.
Ang M, Mehta JS, Mantoo S, Tan D. Deep anterior lamellar keratoplasty to treat microsporidial stromal keratitis. Cornea 2009;28:832-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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