A patient with chronic nonresponse keratitis presented to Bascom Palmer with a 2 year history of progressive eye pain and blurry vision in the left eye. He was initially diagnosed with herpes stromal keratitis of the left eye and was treated for >1 year with steroids and Valtrex with minimal improvement. He was consequently diagnosed with acanthamoeba keratitis by a different physician and treated again without response. At Bascom palmer he presented with 20/20 vision and IOP of 10 in the right unaffected eye, and 20/200 vision and IOP 18 in the affected left eye. Exam showed diffuse KP, bullae and MCE, and a diffuse stromal haze / edema without an epi defect or AC cell / inflammation. The patient was cultured, taken for confocal microscopy, and additionally a corneal biopsy was performed in order to obtain the diagnosis of Microsporidial Keratitis. In a patient with non-responsive presumed infectious keratitis without a known organism, PCR, biopsy, and in vivo confocal microscopy (IVCM) are all useful additional diagnostics which should be incorporated into the working diagnostic algorithm. Microsporidial Keratitis is a rare entity, and on IVCM, this organism appears as hyperreflective ovoid bodies; PCR has a high sensitivity and specificity via tissue sampling; and corneal biopsy allows one to attain stromal tissue which is otherwise inaccessible from normal culture methods. Treatment for MSK generally involves PK, as medical management usually is not adequate alone for this indolent and scarring stromal infection.
Presentation Date: 12/01/2022
Issue Date: 12/23/2022