Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis

1
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
2
Microsporidia

• Ubiquitous, intracellular, eukaryotic, spore
  forming parasite
• Opportunistic pathogen
• Systemic infections
• Immuno-compromised patients

3
Microsporidia
Clinical presentation

• Keratoconjunctivitis
• Stromal keratitis

- Uncommon - 13 cases reported 05 cases reported
from LVPEI - Immuno-competent
4
Microsporidial stromal keratitis
Study design

• Retrospective consecutive case series
• January 2002 December 2009

- Detailed clinical examination - Microbiology
work-up - Pathology of excised corneal tissue
5
Microsporidial stromal keratitis
Results

• Age 2 to 77 years
• MF 177
• Duration of symptoms 30 - 1460 days

17 had symptoms gt 60 days 10 of these had
symptoms gt 1 year
6
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)

7
Microsporidial stromal keratitis
Clinical picture at presentation
8
Microsporidial stromal keratitis
Clinical Diagnosis

• Herpes simplex stromal keratitis (n10 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
9
Microsporidial stromal keratitis
Laboratory diagnosis

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

Duration between presentation and diagnosis
varied from 1 day to 3 years
10
Microsporidial stromal keratitis
Results
Medical Treatment (n 15)

• Topical
• PHMB 0.02
• Chlorhexidine 0.02
• Oral
• Albendazole
• Ketoconazole

11
Microsporidial stromal keratitis
Results
Surgical Treatment (n 20)

• PKP (n 19)
• Lamellar (n 1)

12
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