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Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes

Purpose: The purpose of this paper is to report the clinical manifestations, diagnostic evaluation, management and outcomes of microsporidial keratitis in post-keratoplasty eyes. Methods: This is a retrospective review of three patients diagnosed with microsporidial stromal keratitis in post-keratop...

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Autores principales: Spena, Rossella, Bovone, Cristina, Ciarmatori, Nicolò, Pellegrini, Marco, Yu, Angeli Christy, Zauli, Giorgio, Busin, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253265/
https://www.ncbi.nlm.nih.gov/pubmed/37297901
http://dx.doi.org/10.3390/jcm12113706
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author Spena, Rossella
Bovone, Cristina
Ciarmatori, Nicolò
Pellegrini, Marco
Yu, Angeli Christy
Zauli, Giorgio
Busin, Massimo
author_facet Spena, Rossella
Bovone, Cristina
Ciarmatori, Nicolò
Pellegrini, Marco
Yu, Angeli Christy
Zauli, Giorgio
Busin, Massimo
author_sort Spena, Rossella
collection PubMed
description Purpose: The purpose of this paper is to report the clinical manifestations, diagnostic evaluation, management and outcomes of microsporidial keratitis in post-keratoplasty eyes. Methods: 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). Results: 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. Conclusions: Prior to definitive surgery, confocal microscopy can be employed for the in vivo detection of pathogenic microorganisms such as Microsporidium. 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.
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spelling pubmed-102532652023-06-10 Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes Spena, Rossella Bovone, Cristina Ciarmatori, Nicolò Pellegrini, Marco Yu, Angeli Christy Zauli, Giorgio Busin, Massimo J Clin Med Case Report Purpose: The purpose of this paper is to report the clinical manifestations, diagnostic evaluation, management and outcomes of microsporidial keratitis in post-keratoplasty eyes. Methods: 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). Results: 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. Conclusions: Prior to definitive surgery, confocal microscopy can be employed for the in vivo detection of pathogenic microorganisms such as Microsporidium. 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. MDPI 2023-05-27 /pmc/articles/PMC10253265/ /pubmed/37297901 http://dx.doi.org/10.3390/jcm12113706 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Spena, Rossella
Bovone, Cristina
Ciarmatori, Nicolò
Pellegrini, Marco
Yu, Angeli Christy
Zauli, Giorgio
Busin, Massimo
Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title_full Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title_fullStr Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title_full_unstemmed Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title_short Microsporidial Stromal Keratitis in Post-Keratoplasty Eyes
title_sort microsporidial stromal keratitis in post-keratoplasty eyes
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253265/
https://www.ncbi.nlm.nih.gov/pubmed/37297901
http://dx.doi.org/10.3390/jcm12113706
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