Farooqui Javed Hussain, Acharya Manisha, Gandhi Arpan, Mathur Umang
Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
Laboratory Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
GMS Ophthalmol Cases. 2020 Feb 14;10:Doc01. doi: 10.3205/oc000128. eCollection 2020.
To report 3 cases of microsporidial stromal keratitis presenting as a diagnostic dilemma to a tertiary eye care center in north India. Three eyes of 3 patients underwent therapeutic keratoplasty for microsporidial stromal keratitis. A decision for early surgery was taken as the patients were not responding to conventional medical management and were worsening clinically. The diagnosis of microsporidia was made by corneal scraping and confirmed on histopathological evaluation of the corneal button. Out of the 3 patients, one maintained a clear graft, one had a recurrence and one had graft rejection, 6 months postoperatively. The patients were not started on steroids in the postoperative period and were given topical antibiotics and polyhexamethylene biguanide (PHMD). Oral Albendazole 400 mg was also given twice a day for a month. Many questions remained unanswered about the management protocol of stromal keratitis caused by microsporidia. The role of topical steroids, antifungal agents, oral Albendazole needs to be discussed. Clinicians should be aware of recurrences which may mimic as rejections. There needs to be more awareness regarding microsporidia as a cause of acute stromal keratitis, so that its not overlooked or underdiagnosed.
报告3例微孢子虫性基质性角膜炎病例，这些病例给印度北部一家三级眼科护理中心带来了诊断难题。3例患者的3只眼睛因微孢子虫性基质性角膜炎接受了治疗性角膜移植术。由于患者对传统药物治疗无反应且临床症状恶化，因此决定尽早进行手术。通过角膜刮片诊断出微孢子虫，并在对角膜植片进行组织病理学评估时得到证实。3例患者中，1例术后6个月植片保持透明，1例复发，1例发生植片排斥反应。患者术后未使用类固醇，给予局部抗生素和聚六亚甲基双胍（PHMD）。还每天口服阿苯达唑400毫克，持续一个月。关于微孢子虫引起的基质性角膜炎的治疗方案，仍有许多问题未得到解答。局部类固醇、抗真菌药物、口服阿苯达唑的作用需要讨论。临床医生应意识到可能类似排斥反应的复发情况。需要提高对微孢子虫作为急性基质性角膜炎病因的认识，以免其被忽视或诊断不足。
