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Microsporidial spores can cross the intact Descemet membrane in deep stromal infection

Somasheila I Murthy1, Vishram A Sangit, Varsha M Rathi

  • 1Department of Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh, India.

Middle East African Journal of Ophthalmology
|April 13, 2013
PubMed

Insights

Microsporidial keratitis, a rare deep stromal infection, can progress despite treatment. This case shows microsporidia crossing the intact Descemet

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Deep stromal keratitis presents a diagnostic challenge, particularly in chronic, indolent cases.
  • Microsporidial keratitis is a rare but significant cause of infectious keratitis.
  • Accurate diagnosis is crucial for effective treatment and visual preservation.

Observation:

  • A rare case of deep stromal keratitis with a chronic indolent course was diagnosed as microsporidial keratitis.
  • Despite medical therapy, the patient's condition deteriorated, necessitating penetrating keratoplasty.
  • Histopathology revealed microsporidial spores in the posterior stroma and endothelial exudates.

Findings:

  • Microsporidial spores were found to cross the intact Descemet's membrane, a finding previously reported in only one other case.
  • This challenges the understanding of the typical routes of microbial invasion in the cornea.
  • The presence of spores in endothelial exudates suggests hematogenous or lymphatic spread.

Implications:

  • This case highlights the potential for microsporidia to breach corneal barriers, impacting treatment strategies.
  • Further research is needed to understand the mechanisms of microsporidial invasion across intact membranes.
  • Clinicians should consider microsporidial keratitis in refractory stromal keratitis cases, even without apparent corneal defects.
Keywords:
Anterior Chamber ExudatesLamellar KeratoplastyMicrosporidial Stromal KeratitisPenetrating KeratoplastySpores in Anterior Chamber

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