Deep anterior lamellar keratoplasty to treat microsporidial stromal keratitis.
OBJECTIVE
To describe deep anterior lamellar keratoplasty (DALK) as a surgical option to treat a case of severe microsporidial stromal keratitis in an immunocompetent patient.


METHODS
This study is a descriptive case report. A 42 year-old Pakistani woman had an 8-year history of symptoms in the left eye. She had been previously provisionally diagnosed as suspected herpes simplex keratitis or Thygeson keratitis. At presentation, her best-corrected visual acuity was 20/20 OD and 20/200 OS. Examination of the left cornea revealed irregular, central, deep stromal opacification with keratitic precipitates and occasional cells in the anterior chamber. Investigations for mycobacteria, syphilis, and a tetraplex test were normal; all other hematological/biochemistry/virology investigations were normal-she was not found to be immunocompromised.


RESULTS
A corneal biopsy confirmed microsporidial infiltration of the stroma. After intensive medical treatment with topical fumagillin and oral albendazole without resolution, DALK was performed with total stromal replacement using the big-bubble technique. One year postoperatively, the graft remained clear with no evidence of recurrence and best-corrected visual acuity was 20/40 OS.


CONCLUSIONS
Microsporidial stromal keratitis is rare. Conventional surgical treatment for such a condition has been penetrating keratoplasty. DALK may be considered an option for visual rehabilitation in these cases.
Ang
Marcus
M
Singapore National Eye Centre, Singapore 168751, Singapore.
Mehta
Jodhbir S
JS
Mantoo
Sangeeta
S
Tan
Donald
D
D000328:Adult; D003319:Corneal Stroma / Q000382:microbiology*; D016039:Corneal Transplantation; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology / Q000601:surgery*; D016814:Microsporidia / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000382:microbiology / Q000601:surgery*; D014792:Visual Acuity