Cornea and Anterior Segment Services, The Cornea Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India.
Uveitis and Vitreo-retina Services, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India.
Cornea. 2023 Nov 1;42(11):1439-1445. doi: 10.1097/ICO.0000000000003230. Epub 2023 Jan 18.
The aim of this study was to describe the clinical features and management of uveitis associated with microsporidial keratoconjunctivitis (MKC).
The medical records of clinically diagnosed or microbiologically proven patients with MKC between July 2016 and August 2021 were reviewed. Patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells were analyzed for their demography, clinical features, and treatment. Patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis were excluded from the study.
Of the 2212 patients reviewed within the study period 171 of 172 eyes (7.7%) had documented evidence of KPs and/or anterior chamber cells. The patients' mean age was 43.8 ± 13.8 years, and there were more men (n = 120). The mean duration of appearance of KPs was 6.9 ± 5.5 days, and 28% (n = 48 of 171) appeared on the day of presentation. Superficial punctate keratitis was central and diffuse in 48 and 49 patients, respectively. The treatment was either lubricant alone (45.3%; 78 eyes) or combined with topical steroids (54.7%; 94 eyes). The mean duration of the resolution was longer in the "corticosteroid" than "no corticosteroid" group: KPs: 15.3 ± 6.5 days versus 12.3 ± 5.8 days ( P = 0.007) and superficial punctate keratitises: 15.4 ± 9.4 days versus 11.7 ± 6.2 days ( P = 0.01). The presenting visual acuity with a pinhole was 0.26 ± 0.26 (logMAR) and it improved to 0.03 ± 0.07 on resolution ( P < 0.0001, paired t test).
Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions.
本研究旨在描述与微孢子虫性角结膜炎（MKC）相关的虹膜炎的临床特征和治疗方法。
回顾了 2016 年 7 月至 2021 年 8 月期间临床诊断或微生物学确诊的 MKC 患者的病历。对有记录的角膜后沉淀物（KP）或前房细胞的患者进行了人口统计学、临床特征和治疗分析。本研究排除了微孢子虫性基质性角膜炎和单纯疱疹病毒性角膜炎合并虹膜炎的患者。
在所审查的 2212 例患者中，有 171 例（7.7%）眼有记录的 KP 和/或前房细胞。患者的平均年龄为 43.8 ± 13.8 岁，其中男性（n = 120）居多。KP 出现的平均时间为 6.9 ± 5.5 天，28%（n = 48 of 171）在就诊当天出现。48 例患者的浅层点状角膜炎呈中央型和弥漫型，49 例患者的浅层点状角膜炎呈弥漫型。治疗方法为单独使用润滑剂（45.3%；78 眼）或联合使用局部皮质类固醇（54.7%；94 眼）。在“皮质类固醇”组和“无皮质类固醇”组中，KP 的消退时间较长：KP：15.3 ± 6.5 天 vs. 12.3 ± 5.8 天（P = 0.007），浅层点状角膜炎：15.4 ± 9.4 天 vs. 11.7 ± 6.2 天（P = 0.01）。就诊时的视力为 0.26 ± 0.26（logMAR），在痊愈时提高到 0.03 ± 0.07（P < 0.0001，配对 t 检验）。
MKC 后虹膜炎是一种自限性疾病，通常无需皮质类固醇即可缓解。在存在活动性角膜病变的情况下，使用皮质类固醇时必须谨慎。
