Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Odisha, India.
Ocular Microbiology Service, L.V. Prasad Eye Institute, Odisha, India.
Semin Ophthalmol. 2021 Nov 17;36(8):818-823. doi: 10.1080/08820538.2021.1923762. Epub 2021 May 19.
: To describe the clinical course and propose a morphological classification scheme of microsporidial keratoconjunctivitis. : This is a prospective study at L V Prasad Eye Institute, Odisha, between August-January (2017-19). Patients of any age or sex, microbiologically proven as microsporidial keratoconjunctivitis were included. Demographic parameters, history, clinical course, and visual outcome were analysed. All received artificial tear substitutes till resolution and topical immunosuppressants used in cases of persisting sub-epithelial infiltrates (SEI) beyond 2 weeks. : Fifty-three eyes of 47 cases were included with males, 72.3%. Corneal lesions were classified into 3 morphological types- coarse, ring, and flat-topped (Type1, 2 & 3). Depending upon the location, Type 1 was further sub-divided into peripheral, paracentral, central, and diffuse (Type 1a, b, c & d). The mean age was highest in Type 3( = .026). Risk factors and prior steroid use were most common in Type 1d. The mean duration of symptom before presentation was longest in Type 3(11.6 ± 3.65) days. Severe conjunctival congestion at presentation in more than half of the eyes were seen in Type 1a, 1b and 1d, with moderate congestion at Day14 persisting in 66.7% and 40% of eyes belonging to Type 1c and 1d, respectively. Keratic precipitates were most common in Type 2. The mean duration of resolution was longest in Type 1d (38 ± 15.87) days and shortest in type 1b (7.88 ± 2.47) days ( = .022). Persistent SEIs beyond Day 90 were seen in total of 6 (11.3%) (Type 1c & 1d- 3 each) eyes and recurrent SEIs in 7(13.2%) (Type 1c-2 & 1d- 5) eyes. The mean duration of topical steroids use was longest in Type 1d (49.3 ± 22.3) days, followed by Type 1c (28 ± 0) days. : Microsporidial keratoconjunctivitis can have a variable clinical presentation, the course of each being different depending on the host and ocular surface factors. Though considered as a self-limiting disease, central and diffuse coarse variety (Type1c&1d) required long-term topical immunosuppressants and follow-up.
描述微孢子虫性角膜炎的临床过程并提出形态学分类方案。
这是在奥里萨邦 L V Prasad 眼科研究所进行的一项前瞻性研究，时间为 2017 年 8 月至 2019 年 1 月。纳入了任何年龄和性别的微生物学证实为微孢子虫性角膜炎的患者。分析了人口统计学参数、病史、临床过程和视力结果。所有患者均接受人工泪液替代物治疗，直至痊愈，并在亚上皮浸润（SEI）持续超过 2 周的情况下使用局部免疫抑制剂。
共纳入 47 例 53 只眼的患者，其中男性占 72.3%。角膜病变分为 3 种形态类型-粗糙、环状和平顶（类型 1、2 和 3）。根据位置，类型 1 进一步细分为周边、旁中心、中央和弥漫性（类型 1a、1b、1c 和 1d）。类型 3 的平均年龄最高（=0.026）。危险因素和先前使用类固醇在 1d 型中最为常见。在就诊前出现症状的平均持续时间在类型 3 中最长（11.6±3.65）天。超过一半的眼在就诊时出现严重的结膜充血，在 1a、1b 和 1d 型中，在第 14 天仍有中度充血，66.7%和 40%的眼属于 1c 和 1d 型。2 型中最常见的是角膜后沉淀物。1d 型的平均愈合时间最长（38±15.87）天，1b 型最短（7.88±2.47）天（=0.022）。总共有 6 只（11.3%）（1c 型和 1d 型各 3 只）眼的 SEI 持续时间超过 90 天，7 只（13.2%）（1c 型 2 只和 1d 型 5 只）眼的 SEI 复发。1d 型的局部类固醇使用时间最长（49.3±22.3）天，其次是 1c 型（28±0）天。
微孢子虫性角膜炎的临床表现可有多种变化，其病程因宿主和眼表因素的不同而不同。虽然被认为是一种自限性疾病，但中央和弥漫性粗糙型（1c 型和 1d 型）需要长期使用局部免疫抑制剂和随访。
