PURPOSE: To describe deep anterior lamellar keratoplasty (DALK) as a surgical option to treat a case of severe microsporidial stromal keratitis in an immunocompetent patient. MATERIALS AND METHODS: This study is a descriptive case report. A 42 year-old Pakistani woman had an 8-year history of symptoms in the left eye. She had been previously provisionally diagnosed as suspected herpes simplex keratitis or Thygeson keratitis. At presentation, her best-corrected visual acuity was 20/20 OD and 20/200 OS. Examination of the left cornea revealed irregular, central, deep stromal opacification with keratitic precipitates and occasional cells in the anterior chamber. Investigations for mycobacteria, syphilis, and a tetraplex test were normal; all other hematological/biochemistry/virology investigations were normal-she was not found to be immunocompromised. RESULTS: A corneal biopsy confirmed microsporidial infiltration of the stroma. After intensive medical treatment with topical fumagillin and oral albendazole without resolution, DALK was performed with total stromal replacement using the big-bubble technique. One year postoperatively, the graft remained clear with no evidence of recurrence and best-corrected visual acuity was 20/40 OS. CONCLUSIONS: Microsporidial stromal keratitis is rare. Conventional surgical treatment for such a condition has been penetrating keratoplasty. DALK may be considered an option for visual rehabilitation in these cases.
PURPOSE: To describe deep anterior lamellar keratoplasty (DALK) as a surgical option to treat a case of severe microsporidial stromal keratitis in an immunocompetent patient. MATERIALS AND METHODS: This study is a descriptive case report. A 42 year-old Pakistani woman had an 8-year history of symptoms in the left eye. She had been previously provisionally diagnosed as suspected herpes simplex keratitis or Thygeson keratitis. At presentation, her best-corrected visual acuity was 20/20 OD and 20/200 OS. Examination of the left cornea revealed irregular, central, deep stromal opacification with keratitic precipitates and occasional cells in the anterior chamber. Investigations for mycobacteria, syphilis, and a tetraplex test were normal; all other hematological/biochemistry/virology investigations were normal-she was not found to be immunocompromised. RESULTS: A corneal biopsy confirmed microsporidial infiltration of the stroma. After intensive medical treatment with topical fumagillin and oral albendazole without resolution, DALK was performed with total stromal replacement using the big-bubble technique. One year postoperatively, the graft remained clear with no evidence of recurrence and best-corrected visual acuity was 20/40 OS. CONCLUSIONS: Microsporidial stromal keratitis is rare. Conventional surgical treatment for such a condition has been penetrating keratoplasty. DALK may be considered an option for visual rehabilitation in these cases.
Authors: Anna Song; Rashmi Deshmukh; Haotian Lin; Marcus Ang; Jodhbir S Mehta; James Chodosh; Dalia G Said; Harminder S Dua; Darren S J Ting Journal: Front Med (Lausanne) Date: 2021-07-07
Authors: Marcus Ang; Kavya Devarajan; Suchandrima Das; Gary H F Yam; Hla Mynt Htoon; Si Chen; Xinyu Liu; Linbo Liu; Michael Girard; Jodhbir S Mehta Journal: Sci Rep Date: 2018-07-31 Impact factor: 4.379
Authors: Hong The Nguyen; Ngoc Dong Pham; Tung Quoc Mai; Hang Thi Thuy Do; Duong Thi Nga Nguyen; Peter McCluskey; Trong Van Pham Journal: Clin Ophthalmol Date: 2021-08-24
Authors: Majid Moshirfar; Shaan N Somani; Kathryn M Shmunes; Ladan Espandar; Nikhil S Gokhale; Yasmyne C Ronquillo; Phillip C Hoopes Journal: Ophthalmol Ther Date: 2020-03-10