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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.

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Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis

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

  3. Keratoconjunctivitis Stromal keratitis Microsporidia Clinical presentation : - Uncommon - 13 cases reported 05 cases reported from LVPEI - Immuno-competent

  4. Retrospective consecutive case series January 2002 – December 2009 Microsporidial stromal keratitis Study design : - Detailed clinical examination - Microbiology work-up - Pathology of excised corneal tissue

  5. 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

  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 (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

  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

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