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Microsporidial Stromal Keratitis: Epidemiological Features, Slit-Lamp Biomicroscopic Characteristics, and Therapy.
- Source :
-
Cornea [Cornea] 2021 Dec 01; Vol. 40 (12), pp. 1532-1540. - Publication Year :
- 2021
-
Abstract
- Purpose: Microsporidial stromal keratitis is a rare form of infectious keratitis, with only 7 cases reported in the United States to date. This study was performed to evaluate risk factors, clinical features, and response to therapy.<br />Methods: A retrospective review of the medical records of all patients diagnosed with microsporidial stromal keratitis seen in the practices of the authors between 1999 and 2020 was performed. Diagnosis was determined by cytology or histopathology in corneal specimens. Risk factors, presence or absence of distinctive clinical features, and response to medical and surgical therapies were recorded.<br />Results: Nine patients-7M:2F, aged 7 to 99 years-with microsporidial stromal keratitis were identified. Exposures to recreational water and hymenopteran insect bites, both epidemiologically linked risk factors for systemic microsporidial infection, were identified in our patients. Presence of stromal edema with features of disciform keratitis and a distinctive granular keratitis were observed in 6 of 9 and 5 of 9 patients, respectively. Poor response to medical therapy was noted. Penetrating keratoplasty was effective in curing the infection. Final visual acuity was 20/40 or better in 6 of 9 patients.<br />Conclusions: In patients with slowly progressive keratitis, history of exposure to recreational water or hymenopteran insects should be sought. In patients with corneal edema consistent with disciform keratitis, with evolution to a granular keratitis, microsporidia should be considered in the differential diagnosis. In cases of established microsporidial stromal keratitis, penetrating keratoplasty should be considered if prompt response to medical therapy is not noted.<br />Competing Interests: The authors have no conflicts of interest to disclose.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Biopsy
Child
Corneal Stroma microbiology
Eye Infections, Fungal diagnosis
Eye Infections, Fungal therapy
Female
Follow-Up Studies
Humans
Incidence
Keratitis diagnosis
Keratitis therapy
Male
Microsporidia isolation & purification
Microsporidiosis diagnosis
Microsporidiosis therapy
Middle Aged
Retrospective Studies
United States epidemiology
Visual Acuity
Young Adult
Antifungal Agents therapeutic use
Corneal Stroma pathology
Eye Infections, Fungal epidemiology
Keratitis epidemiology
Keratoplasty, Penetrating methods
Microsporidiosis epidemiology
Slit Lamp Microscopy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1536-4798
- Volume :
- 40
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Cornea
- Publication Type :
- Academic Journal
- Accession number :
- 33782266
- Full Text :
- https://doi.org/10.1097/ICO.0000000000002704