PMC3617535_01
(a and b) Slit lamp photographs showing the dense corneal infiltrates at presentation. (c) Persistence of stromal infiltrates three weeks after therapy. (d) Clear graft two months following penetrating keratoplasty
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PMC3617535_01_MEAJO-20-80-g001.jpg
F1
Slit lamp examination showed intact, edematous epithelium, while the underlying stroma showed multiple, gray-white irregular to oval shaped flocculent infiltrates with indistinct borders; diffusely distributed over the entire cornea (except the limbus), involving the deep stroma [Figures 1a and b]. Medical therapy was instituted with topical 0.02% chlorhexidine gluconate ever half-hour and oral albendazole 400mg twice daily; however here was no response even after three weeks [Figure 1c]. The visual acuity improved to 20/20 within two months [Figure 1d].
(a) Section of the cornea shows epithelial ulceration, dense stromal infiltrates and AC exudates posterior to and separate from the DM (H and E, x10). The DM is intact through the specimen. (b) 1% acid fast stain shows brightly stained microsporidial spores within the posterior stroma. (c) Under higher magnification (x100), the spores show the characteristic waist-band. (d) x100 magnification with 1% acid fast stain showing presence of microsporidial spore (arrow) in the AC exudate
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F2
Numerous microsporidial spores were present in the deeper stroma upto the DM [Figures 2a-c] on Gram stain and 1% acid-fast stain. The AC exudates noted in some sections showed the presence of microsporidial spores [Figure 2d arrow].