Cornea and Anterior Segment, LV Prasad Eye Institute, Bhubaneswar, Odisha, India.
Ocular Microbiology Services, LV Prasad Eye Institute, Bhubaneswar, Orissa, India.
Br J Ophthalmol. 2023 May;107(5):607-613. doi: 10.1136/bjophthalmol-2021-319784. Epub 2021 Dec 22.
To describe the clinical features, diagnosis and management of immune stromal keratitis/interstitial keratitis (IK) associated with microsporidial epithelial keratitis.
Between October 2020 and January 2021, medical records of IK patients microbiologically proven as microsporidia from samples collected from corneal epithelium on smear examination, and/ or molecular analysis were reviewed. Demography, clinical profile and treatment were analysed. Real-time PCR (RT-PCR) for adenovirus (ADV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) was done.
Twenty of 152 (13%) microbiologically proven cases of microsporidial keratitis were diagnosed as IK during the study period, the mean age and duration of symptoms were 35.7±11.4 years and 46.3±27.7 days, respectively. Half had predisposing risk factors, like trauma; and 30% had prior recurrences. One-fourth of patients were using antivirals on presentation. Characteristic presentations included disciform keratitis(n=12), incomplete/complete ring(n=5), and combination(n=3), along with variable subepithelial infiltrates (n=14). All cases had stromal oedema, with an intact epithelium and fine pigment dusting on endothelium. Corneal epithelial scrapings had scanty microsporidia spores in smears of 17/20 (85%), and pan-microsporidial DNA was identified in 14/20 (70%), with Vittaforma corneae by sequencing in 11/20 (55%). Other viruses detected were ADV (14,70%), VZV (2,10%), EBV (1,5%) and HSV (1,5%). Rapid resolution of inflammation and oedema within 2 weeks of starting steroids was seen in all cases.
Microsporidia epithelial keratitis induced stromal inflammatory keratitis; is distinguished from microsporidial keratoconjunctivitis and stromal keratitis, by characteristic clinical features, and response to topical steroids.
描述与微孢子虫性上皮角膜炎相关的免疫性基质性角膜炎/间质性角膜炎（IK）的临床特征、诊断和治疗方法。
在 2020 年 10 月至 2021 年 1 月期间，对通过角膜上皮刮片检查和/或分子分析微生物学证实为微孢子虫的 IK 患者的病历进行了回顾性分析。分析了人口统计学、临床特征和治疗方法。进行了实时聚合酶链反应（RT-PCR）检测腺病毒（ADV）、爱泼斯坦-巴尔病毒（EBV）、单纯疱疹病毒（HSV）和水痘-带状疱疹病毒（VZV）。
在研究期间，152 例微生物学证实的微孢子虫角膜炎病例中，有 20 例（13%）被诊断为 IK，平均年龄和症状持续时间分别为 35.7±11.4 岁和 46.3±27.7 天。一半的患者有创伤等潜在危险因素，30%的患者有复发史。四分之一的患者在就诊时正在使用抗病毒药物。特征性表现包括盘状角膜炎（n=12）、不完整/完整环（n=5）和组合（n=3），同时伴有不同程度的上皮下浸润（n=14）。所有病例均有基质水肿，上皮完整，内皮有细色素尘。20 例中的 17 例（85%）角膜上皮刮片的涂片中有少量微孢子虫孢子，14 例（70%）中检测到全微孢子虫 DNA，其中 11 例（55%）通过测序检测到 Vittaforma corneae。其他检测到的病毒包括 ADV（14，70%）、VZV（2，10%）、EBV（1，5%）和 HSV（1，5%）。所有病例在开始使用类固醇后 2 周内炎症和水肿迅速消退。
微孢子虫性上皮角膜炎引起的基质炎症性角膜炎；通过特征性的临床特征和对局部类固醇的反应，与微孢子虫性角膜炎和基质角膜炎区分开来。
