Spena Rossella, Bovone Cristina, Ciarmatori Nicolò, Pellegrini Marco, Yu Angeli Christy, Zauli Giorgio, Busin Massimo
Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy.
Department of Ophthalmology, Ospedali Privati Forlì "Villa Igea", 47122 Forlì, Italy.
J Clin Med. 2023 May 27;12(11):3706. doi: 10.3390/jcm12113706.
The purpose of this paper is to report the clinical manifestations, diagnostic evaluation, management and outcomes of microsporidial keratitis in post-keratoplasty eyes.
This is a retrospective review of three patients diagnosed with microsporidial stromal keratitis in post-keratoplasty eyes between January 2012 and December 2021 at a tertiary referral center (Ospedali Privati Forlì "Villa Igea", Forlì, Italy).
All patients presented with fine multifocal granular infiltrates following keratoplasty for a presumed herpetic keratitis. No microorganisms were isolated from the corneal scrapings and no clinical response was observed with broad-spectrum antimicrobial therapy. In all cases, confocal microscopy demonstrated spore-like structures. The histopathologic examination of the excised corneal buttons confirmed the diagnosis of microsporidial stromal keratitis. Following therapeutic keratoplasty and treatment with an initial high dose and extended taper of topical fumagillin, clinical resolution was achieved in all eyes. The Snellen visual acuities at the final follow-up were 20/50, 20/63 and 20/32.
Prior to definitive surgery, confocal microscopy can be employed for the in vivo detection of pathogenic microorganisms such as . In post-keratoplasty eyes, therapeutic keratoplasty and an initial high dose of topical fumagillin with extended taper can allow the resolution of microsporidial stromal keratitis with a satisfactory visual prognosis.
本文旨在报告角膜移植术后眼微孢子虫性角膜炎的临床表现、诊断评估、治疗及预后。
这是一项对2012年1月至2021年12月期间在一家三级转诊中心（意大利弗利“伊盖亚别墅”私立医院）被诊断为角膜移植术后眼微孢子虫性基质性角膜炎的3例患者的回顾性研究。
所有患者在因疑似疱疹性角膜炎接受角膜移植术后均出现细小的多灶性颗粒状浸润。角膜刮片中未分离出微生物，广谱抗菌治疗也未观察到临床反应。在所有病例中，共焦显微镜检查显示有孢子样结构。切除的角膜植片的组织病理学检查证实了微孢子虫性基质性角膜炎的诊断。在接受治疗性角膜移植并使用初始高剂量和逐渐减量的局部夫马洁林治疗后，所有患眼均实现了临床治愈。最后一次随访时的斯内伦视力分别为20/50、20/63和20/32。
在进行确定性手术之前，共焦显微镜检查可用于在体内检测诸如……等致病微生物。在角膜移植术后眼中，治疗性角膜移植以及初始高剂量并逐渐减量的局部夫马洁林治疗可使微孢子虫性基质性角膜炎得到治愈，并获得令人满意的视力预后。
