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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
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Ubiquitous, intracellular, eukaryotic, spore forming parasite Opportunistic pathogen Systemic infections Immuno-compromised patients MicrosporidiaMicrosporidia
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Keratoconjunctivitis Stromal keratitis Clinical presentation : MicrosporidiaMicrosporidia - Uncommon - 13 cases reported 05 cases reported from LVPEI - Immuno-competent
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Retrospective consecutive case series January 2002 – December 2009 Study design : - Detailed clinical examination - Microbiology work-up - Pathology of excised corneal tissue Microsporidial stromal keratitis
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Age:2 to 77 years M:F :: 17:7 Duration of symptoms : 30 - 1460 days Results: Microsporidial stromal keratitis 17 had symptoms > 60 days 10 of these had symptoms > 1 year
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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)
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Clinical picture at presentation Microsporidial stromal keratitis
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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
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Corneal scrapings (n = 9) Histopathology (n = 21) Microsporidial stromal keratitis Laboratory diagnosis Duration between presentation and diagnosis varied from 1 day to 3 years
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Topical PHMB 0.02% Chlorhexidine 0.02% Oral AlbendazoleKetoconazole Medical Treatment (n = 15) Microsporidial stromal keratitis Results:
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PKP (n = 19) Lamellar (n = 1) Surgical Treatment (n = 20) Microsporidial stromal keratitis Results:
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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
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