title: Femtosecond laser-assisted anterior lamellar keratoplasty in stromal keratitis caused by an Endoreticulatus-like microsporidia.
abstract: OBJECTIVE
  To describe a case of stromal keratitis caused by an Endoreticulatus-like microsporidia satisfactorily treated with femtosecond-assisted anterior lamellar keratoplasty (femto-ALK).
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 65-year-old healthy woman had a 10-month history of foreign body sensation and blurred vision after a flying insect struck her right eye. The patient presented with focal central to paracentral anterior stromal infiltration and edema with keratic precipitates of the right cornea. Confocal microscopy showed enhanced keratocytes with intracellular hyperreflective round and ovoid bodies confined to the anterior two thirds of corneal stroma. Femto-ALK was performed for excisional biopsy and replacement with anterior stromal donor cornea. A modified trichrome stain of corneal tissue showed numerous microsporidial spores whose small subunit rRNA sequence belonged to that of an Endoreticulatus-like microsporidia.
  
  
  CONCLUSIONS
  Besides systemic infection, Endoreticulatus-like microsporidia can cause stromal keratitis. With careful patient selection, femto-ALK may be considered a new surgical alternative with satisfactory treatment outcomes.
authors.affiliation: *Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; and †Molecular Biology of Malaria and Opportunistic Parasites Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Lalida
authors.initials: L
authors.lastname: Pariyakanok
authors.forename: Vannarut
authors.initials: V
authors.lastname: Satitpitakul
authors.forename: Chaturong
authors.initials: C
authors.lastname: Putaporntip
authors.forename: Somchai
authors.initials: S
authors.lastname: Jongwutiwes
mesh_terms: D000368:Aged; D003319:Corneal Stroma / Q000382:microbiology / Q000601:surgery*; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State; D018613:Microscopy, Confocal; D016814:Microsporidia / Q000235:genetics / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D016133:Polymerase Chain Reaction; D012331:RNA, Fungal / Q000235:genetics; D012335:RNA, Ribosomal / Q000235:genetics; D014792:Visual Acuity
chemical_list: D012331:RNA, Fungal; D012335:RNA, Ribosomal