A 36-year-old man presented with a 3-day history of pain, redness and diminution of vision in his left eye. He had received corneal collagen cross-linking (CXL) treatment for keratoconus in the left eye 6 days prior to presentation, elsewhere. A bandage contact lens was inserted at the end of the surgery. On day 4 after the surgery, the patient presented to his surgeon with complaints of pain, redness, marked light sensitivity, and diminution of vision in the operated eye. The surgeon noticed multiple small corneal infiltrates. A presumptive diagnosis of infectious keratitis was made and empirical treatment was started in the form of hourly 0.5% moxifloxacin hydrochloride, hourly 1.3% tobramycin, hourly 5% natamycin. However, clinical deterioration was noted over the next 48 h and the patient was referred to our center.
At the time of presentation to us, the best-corrected visual acuity (BCVA) was 20/25 OD and counting fingers OS. Slit-lamp examination of the left eye showed marked conjunctival injection. A central, large epithelial defect measuring 7.5 X6.0mm was noted on the corneal surface along with multiple coarse, pinhead-size anterior stromal infiltrates (Figure 1A).
The intervening cornea was edematous. and hazy. There was mild anterior chamber reaction.Corneal scrapings staining with Gram and Giemsa staining showed spores characteristic of microsporidia (Figure 1B).
Hourly 0.5% moxifloxacin hydrochloride eyedrops, 2% homatropine eyedrops 4 times a day, 0.5% moxifloxcain eye ointment nocte, and oral albendazole 400mg twice daily were commenced. Corneal debridement was performed twice during the first week of admission. Oral albendazole was continued for 6 weeks. The corneal infiltrates decreased in size and number and eventually disappeared at the end of 6 weeks, leaving a midstromal corneal scar (Figure 2D). At the end of 6 weeks, the BCVA was 20/60 in the left eye.
Reference: . Microsporidial Keratitis after Collagen Cross-linking. Ocul Immunol Inflamm. Gautam,V Jhanji, G Satpathy ,S Khokhar ,Tushar Agarwal . 2013 PubMed PMID: 23978264
All Images, Text and Material is Copyrighted.
At the time of presentation to us, the best-corrected visual acuity (BCVA) was 20/25 OD and counting fingers OS. Slit-lamp examination of the left eye showed marked conjunctival injection. A central, large epithelial defect measuring 7.5 X6.0mm was noted on the corneal surface along with multiple coarse, pinhead-size anterior stromal infiltrates (Figure 1A).
The intervening cornea was edematous. and hazy. There was mild anterior chamber reaction.Corneal scrapings staining with Gram and Giemsa staining showed spores characteristic of microsporidia (Figure 1B).
Hourly 0.5% moxifloxacin hydrochloride eyedrops, 2% homatropine eyedrops 4 times a day, 0.5% moxifloxcain eye ointment nocte, and oral albendazole 400mg twice daily were commenced. Corneal debridement was performed twice during the first week of admission. Oral albendazole was continued for 6 weeks. The corneal infiltrates decreased in size and number and eventually disappeared at the end of 6 weeks, leaving a midstromal corneal scar (Figure 2D). At the end of 6 weeks, the BCVA was 20/60 in the left eye.
Reference: . Microsporidial Keratitis after Collagen Cross-linking. Ocul Immunol Inflamm. Gautam,V Jhanji, G Satpathy ,S Khokhar ,Tushar Agarwal . 2013 PubMed PMID: 23978264
All Images, Text and Material is Copyrighted.
