Femtosecond laser-assisted anterior lamellar keratoplasty in stromal keratitis caused by an Endoreticulatus-like microsporidia.

PURPOSE: 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.