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Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis. Swapnali Sabhapandit, MS Prashant Garg, MD Somasheila Murthy, MS Geeta K Vemuganti, MD Ashok K Reddy, PhD. LV Prasad Eye Institute Hyderabad, India. Authors have no financial interest.

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Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis


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microsporidial stromal keratitis dilemma in clinical diagnosis
Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis

Swapnali Sabhapandit, MS

Prashant Garg, MD

Somasheila Murthy, MS

Geeta K Vemuganti, MD

Ashok K Reddy, PhD

LV Prasad Eye Institute Hyderabad, India

Authors have no financial interest

slide2
Ubiquitous, intracellular, eukaryotic, spore forming parasite

Opportunistic pathogen

Systemic infections

Immuno-compromised patients

Microsporidia

slide3
Keratoconjunctivitis

Stromal keratitis

Microsporidia

Clinical presentation :

- Uncommon

- 13 cases reported

05 cases reported from LVPEI

- Immuno-competent

slide4
Retrospective consecutive case series

January 2002 – December 2009

Microsporidial stromal keratitis

Study design :

- Detailed clinical examination

- Microbiology work-up

- Pathology of excised corneal tissue

slide5

Microsporidial stromal keratitis

Results:

  • Age : 2 to 77 years
  • M:F :: 17:7
  • Duration of symptoms : 30 - 1460 days

17 had symptoms > 60 days

10 of these had symptoms > 1 year

slide6

Microsporidial stromal keratitis

Results:

Predisposing factors

  • Trauma (n = 10)
  • Contact lens (n = 1)
  • No predisposing factor (n = 13)

Pre-presentation diagnosis

  • HSV keratitis (n = 10)
  • HSV or fungal (n = 5)
  • Fungal (n = 4)
slide7

Microsporidial stromal keratitis

Clinical picture at presentation

slide8

Microsporidial stromal keratitis

Clinical Diagnosis

  • Herpes simplex stromal keratitis (n=10; 41.6%)
  • Fungal keratitis (n = 7; 29.1%)
  • Bacterial keratitis (n = 3; 12.5%)
  • Microsporidial keratitis (n = 4; 16.6%)

9 (37.5%) patients were treated as HSV keratitis after presentation

slide9

Microsporidial stromal keratitis

Laboratory diagnosis

  • Corneal scrapings (n = 9)
  • Histopathology (n = 21)

Duration between presentation and diagnosis varied from 1 day to 3 years

slide10

Microsporidial stromal keratitis

Results:

Medical Treatment (n = 15)

  • Topical

PHMB 0.02%

Chlorhexidine 0.02%

  • Oral

Albendazole

Ketoconazole

slide11

Microsporidial stromal keratitis

Results:

Surgical Treatment (n = 20)

  • PKP (n = 19)
  • Lamellar (n = 1)
slide12

Microsporidial stromal keratitis

Summary

Salient features

  • Can occur in any age
  • Slowly progressive disease with indolent course
  • Initial clinical picture mimics HSV stromal keratitis.

High index of suspicion will help diagnosis of this rare disorder