Mandal Sohini, Sucharita Soumya, Deshmukh Vishwajeet, Priyadarshini Smruti Rekha, Sahu Srikant Kumar, Das Sujata
Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
Ocular Pathology Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
Invest Ophthalmol Vis Sci. 2025 Apr 1;66(4):9. doi: 10.1167/iovs.66.4.9.
The purpose of this study was to evaluate the histopathological factors in non-resolving cases of microsporidia stromal keratitis (MSK) through the study of corneal buttons obtained during therapeutic penetrating keratoplasty (TPK).
This was a retrospective noncomparative consecutive case series. This case series included 22 corneal buttons (22 patients) of histologically diagnosed MSK between June 2015 and April 2023. Records of preoperative clinical and microbiological data, and postoperative microbiological and histopathologic data of the corneal buttons were evaluated.
Histologic evaluation was conducted of the buttons for morphologic changes, degree and distribution of inflammatory cells, presence of microsporidial spores, and their degree and distribution within the corneal buttons. This study evaluated 22 patients with MSK, highlighting clinical, microbiological, treatment, and histopathological findings. The mean patient age was 57.1 ± 13.4 years (range = 22-83 years). The median interval from symptom onset to presentation was 4 months, and the mean time from presentation to keratoplasty was 1 month. Microsporidia spores were detected in 59% of cases through smears, with 41% of cases showing no organisms on microbiological tests. Targeted therapy using polyhexamethylene biguanide (PHMB) 0.02% was given in 13 cases, whereas 9 cases were treated empirically. Histopathology showed no significant correlation between the distribution of inflammatory cells and that of microsporidia. Moderate microsporidia severity correlated with longer symptom duration (10.0 ± 6.36 months). These findings underscore the complexity of MSK management and the variable outcomes.
The progression of MSK in advanced stages appears to be influenced by a combination of pathogen-related factors, such as high microsporidial load with deep stromal penetration, and host-related factors, including a pronounced inflammatory response. Additionally, the limited effectiveness of topical PHMB may contribute to disease progression.
本研究的目的是通过对治疗性穿透性角膜移植术（TPK）期间获取的角膜植片进行研究，评估微孢子虫性基质性角膜炎（MSK）未愈病例的组织病理学因素。
这是一项回顾性非对照连续病例系列研究。该病例系列包括2015年6月至2023年4月期间组织学诊断为MSK的22个角膜植片（22例患者）。对角膜植片的术前临床和微生物学数据以及术后微生物学和组织病理学数据记录进行评估。
对植片进行组织学评估，观察形态学变化、炎症细胞的程度和分布、微孢子虫孢子的存在情况及其在角膜植片中的程度和分布。本研究评估了22例MSK患者，突出了临床、微生物学、治疗和组织病理学发现。患者平均年龄为57.1±13.4岁（范围=22 - 83岁）。从症状出现到就诊的中位间隔时间为4个月，从就诊到角膜移植的平均时间为1个月。通过涂片在59%的病例中检测到微孢子虫孢子，41%的病例在微生物学检测中未发现病原体。13例患者使用0.02%的聚六亚甲基双胍（PHMB）进行靶向治疗，而9例患者进行经验性治疗。组织病理学显示炎症细胞分布与微孢子虫分布之间无显著相关性。微孢子虫严重程度为中度与症状持续时间较长相关（10.0±6.36个月）。这些发现强调了MSK管理的复杂性和可变的结果。
MSK晚期的进展似乎受病原体相关因素（如高微孢子虫负荷伴基质深层浸润）和宿主相关因素（包括明显的炎症反应）的综合影响。此外，局部使用PHMB效果有限可能导致疾病进展。
