Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis Swapnali Sabhapandit, MS Prashant Garg, MD Somasheila Murthy, MS Geeta K Vemuganti, MD Ashok K Reddy, PhD LV Prasad Eye Institute Hyderabad, India Authors have no financial interest

 Ubiquitous, intracellular, eukaryotic, spore forming parasite  Opportunistic pathogen  Systemic infections  Immuno-compromised patients MicrosporidiaMicrosporidia

 Keratoconjunctivitis  Stromal keratitis Clinical presentation : MicrosporidiaMicrosporidia - Uncommon - 13 cases reported 05 cases reported from LVPEI - Immuno-competent

 Retrospective consecutive case series  January 2002 – December 2009 Study design : - Detailed clinical examination - Microbiology work-up - Pathology of excised corneal tissue Microsporidial stromal keratitis

 Age:2 to 77 years  M:F :: 17:7  Duration of symptoms : days Results: Microsporidial stromal keratitis 17 had symptoms > 60 days 10 of these had symptoms > 1 year

 Trauma (n = 10)  Contact lens (n = 1)  No predisposing factor (n = 13) Predisposing factors Microsporidial stromal keratitis Results: Pre-presentation diagnosis  HSV keratitis (n = 10)  HSV or fungal (n = 5)  Fungal (n = 4)

Clinical picture at presentation Microsporidial stromal keratitis

 Herpes simplex stromal keratitis (n=10; 41.6%)  Fungal keratitis (n = 7; 29.1%)  Bacterial keratitis (n = 3; 12.5%)  Microsporidial keratitis (n = 4; 16.6%) Clinical Diagnosis Microsporidial stromal keratitis 9 (37.5%) patients were treated as HSV keratitis after presentation

 Corneal scrapings (n = 9)  Histopathology (n = 21) Microsporidial stromal keratitis Laboratory diagnosis Duration between presentation and diagnosis varied from 1 day to 3 years

 Topical PHMB 0.02% Chlorhexidine 0.02%  Oral AlbendazoleKetoconazole Medical Treatment (n = 15) Microsporidial stromal keratitis Results:

 PKP (n = 19)  Lamellar (n = 1) Surgical Treatment (n = 20) Microsporidial stromal keratitis Results:

 Can occur in any age  Slowly progressive disease with indolent course  Initial clinical picture mimics HSV stromal keratitis. Salient features Microsporidial stromal keratitis Summary High index of suspicion will help diagnosis of this rare disorder