Microsporidium stromal keratitis: in vivo confocal findings.
OBJECTIVE
To relate the clinical signs, histopathologic features, and in vivo confocal biomicroscopy findings of a case of stromal microsporidial keratitis and to describe the use of in vivo confocal microscopy to monitor treatment effect.


METHODS
An immunocompetent male patient presented with unilateral indolent stromal keratitis. Stromal microsporidiosis was confirmed after corneal biopsy. He underwent examination that used in vivo confocal microscopy (Heidelberg Retina Tomograph II and Rostock Cornea Module) before and after treatment with topical fumagillin and oral albendazole. Clinicopathologic correlation of the confocal scan was performed.


RESULTS
Corneal biopsy showed extracellular microsporidium spores aligned along keratocytes and corneal lamellae. In vivo confocal scans showed similar morphology, with bright dots aligned along keratocytes. Treatment with antimicrobials and topical steroid gave resolution of active keratitis, correlating with disappearance of the bright spores on repeat in vivo confocal scanning.


CONCLUSIONS
The in vivo confocal microscopy appearance of microsporidial keratitis corresponds to the histologic features from biopsy material. Treatment response may be monitored by using this technique, although definitive diagnosis requires corneal biopsy.
Cornea and External Diseases Service, Moorfields Eye Hospital, London, UK. sagoo@doctors.org.uk
Mandeep S
MS
Sagoo
Jodhbir S
JS
Mehta
Scott
S
Hau
Luciane Dreher
LD
Irion
Alan
A
Curry
Richard E
RE
Bonshek
Stephen J
SJ
Tuft
D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003319:Corneal Stroma / Q000382:microbiology / Q000473:pathology*; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003510:Cyclohexanes / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005231:Fatty Acids, Unsaturated / Q000627:therapeutic use; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D021861:Microsporidia, Unclassified / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012717:Sesquiterpenes / Q000627:therapeutic use
D000935:Antifungal Agents; D003510:Cyclohexanes; D005231:Fatty Acids, Unsaturated; D012717:Sesquiterpenes; C026211:fumagillin; D015766:Albendazole