Stromal Keratitis with Endophthalmitis Caused by Vittaforma Corneae in an Immunocompetent Patient: A Case Report.

Purpose: To describe a case of microsporidial stromal keratitis with endophthalmitis in an immunocompetent patient.Methods: Case reportResults: A 58-year-old HIV-negative man presented with stromal keratitis in his right eye. The patient demonstrated subsequent vitritis, multifocal retinitis and arteritis, and macular edema with recurrent vitreous hemorrhage after therapeutic keratoplasty. Numerous microsporidial spores were detected in corneal tissues by modified trichrome stain. Both corneal tissues and vitreous sample of the affected eye showed positive results by polymerase chain reaction targeting the microsporidial small subunit rRNA gene whose sequences belonged to Vittaforma corneae. Post-keratoplasty and vitrectomy, his best-corrected visual acuity was hand motion due to pale optic disc.Conclusion: Endophthalmitis can be a consequence of microsporidial stromal keratitis in an immunocompetent host. Early recognition and prompt treatment should be considered in patients diagnosed with microsporidial keratitis presenting with mild vitritis, retinitis, and recurrent vitreous hemorrhage.

Case report: atypical presentation of Mycobacterium tuberculosis uveitis preceding nodular scleritis.

BACKGROUND: Intraocular tuberculosis is uncommon and has various clinical presentations. Lack of specific clinical clues can make the diagnosis challenging. The purpose of this study is to report a clinical presentation of tuberculous iridocyclitis that mimics phacolytic glaucoma and has a distinctive inflammatory deposit in the inner side of the cornea. This report is the first to describe the progression of tuberculous iridocyclitis to nodular scleritis without evidence for extraocular tuberculous infection. CASE PRESENTATION: A 78-year-old, immunocompetent woman presented with subacute intraocular inflammation with high intraocular pressure, mimicking phacolytic glaucoma. Distinct pigment keratic precipitates were noted on the first visit. Even though the cataract extraction was uneventful and adequate anti-inflammatory drugs were given, the inflammation did not subside as expected. Seven weeks later, she developed two scleral abscesses, which were subsequently explored for microbiological investigation. The smears of the pus revealed positive acid-fast bacilli stain and PCR for Mycobacterium tuberculosis complex. Eventually, the pus culture grew Mycobacterium tuberculosis. Anti-tuberculosis medications were prescribed. After 1 month of treatment, the abscesses were cured. However, her visual acuity did not improve at the last visit. CONCLUSIONS: This case revealed an unusual presentation and untreated course of tuberculosis iridocyclitis. Pattern of keratic precipitates may indicate the presence of tuberculosis.

Corneal arcus associated with dyslipidemia.

A cross sectional study based on 243 subjects with an age range of 20-63 years, was conducted to assess the prevalence of corneal arcus and the association between corneal arcus and dyslipidemia which is a coronary heart disease risk factor. The presence of corneal arcus was determined by hand-held slitlamp, serum lipids and serum plasma glucose collected on the same day as corneal arcus detection. Total cholesterol (CHOL), triglyceride (TG) and high density lipoprotein (HDL) were measured by enzymatic procedure, and low density lipoprotein (LDL) was estimated by the Friedewald formula. The prevalence of corneal arcus was divided into 3 age groups, 20-29 years (0%), 30-49 years (male 41.5%, female 26.13%) and 50-69 years (male 86.2%, female 59.1%) In the 30-49 year, female group, those with corneal arcus had higher serum LDL and total cholesterol concentration than those without corneal arcus. The mean difference of LDL was 22.21 mg/dl (p=0.001) and total cholesterol was 30.95 mg/dl (p=0.000). In the 30-49 year, male group people with corneal arcus had a lower serum HDL concentration than those without corneal arcus and the mean difference of the HDL was 8.6 mg/dl (p=0.014). There was no difference for corneal arcus and serum lipid in the 50-69 years group in both sexes. No association between corneal arcus and fasting plasma glucose was found in all ages and both sexes. It is concluded that while corneal arcus is primarily an aged-related change, if present in people under 50 years it should be considered for dyslipidemia which is one of the risk factors for coronary heart disease.