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Deep Anterior Lamellar Keratoplasty to Treat Microsporidial Stromal Keratitis

Ang, Marcus MBBS; Mehta, Jodhbir S FRCOphth; Mantoo, Sangeeta MBBS; Tan, Donald FRCOphth

doi: 10.1097/ICO.0b013e3181930ddc
Case Report

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

Materials and 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.

From the *Singapore National Eye Centre, Singapore; †Singapore Eye Research Institute, Singapore; and ‡Department of Pathology, Singapore General Hospital, Singapore.

Received for publication April 14, 2008; revision received October 6, 2008; accepted October 22, 2008.

None of the authors has a proprietary interest.

Reprints: Dr. Donald Tan, FRCOphth, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751 (e-mail:

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.