TY - JOUR
T1 - Chlorhexidine in the treatment of microsporidial stromal keratitis and the effect of host immunity
T2 - A case series and literature review
AU - Yeh, Tsai Chu
AU - Kuo, Yih Shiuan
AU - Wang, Lei Chi
AU - Tai, Tzu Yang
AU - Lin, Pei Yu
N1 - Publisher Copyright:
Copyright © 2021, the Chinese Medical Association.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Microsporidial stromal keratitis is an increasingly well-known vision-threatening disease. A large proportion of cases are initially misdiagnosed as herpes simplex keratitis and treated with topical steroids. In most of such cases, medical treatment failed, and corneal transplantation was required. This study reported the results of 0.02% topical chlorhexidine used to treat three cases of microsporidial stromal keratitis and reviewed the literature on the outcomes of microsporidial stromal keratitis treatment. In the first case, histopathology of a specimen from penetrating keratoplasty (PK) revealed severe chronic inflammation involving the entire stromal layer but no microorganism activity after the application of topical chlorhexidine for 10 months. The second case exhibited complete resolution of keratitis after topical chlorhexidine. The patient in the third case did not respond to medical treatment, and therapeutic PK was performed. Histopathological examination revealed numerous microsporidial spores that had colonized in the mid and deep stroma, where few inflammatory cells were observed. These findings explain the variable microsporidial susceptibility to chlorhexidine, suggesting the crucial role of host immunity. In cases of host immunity, topical chlorhexidine may represent a promising option for the treatment of microsporidial stromal keratitis.
AB - Microsporidial stromal keratitis is an increasingly well-known vision-threatening disease. A large proportion of cases are initially misdiagnosed as herpes simplex keratitis and treated with topical steroids. In most of such cases, medical treatment failed, and corneal transplantation was required. This study reported the results of 0.02% topical chlorhexidine used to treat three cases of microsporidial stromal keratitis and reviewed the literature on the outcomes of microsporidial stromal keratitis treatment. In the first case, histopathology of a specimen from penetrating keratoplasty (PK) revealed severe chronic inflammation involving the entire stromal layer but no microorganism activity after the application of topical chlorhexidine for 10 months. The second case exhibited complete resolution of keratitis after topical chlorhexidine. The patient in the third case did not respond to medical treatment, and therapeutic PK was performed. Histopathological examination revealed numerous microsporidial spores that had colonized in the mid and deep stroma, where few inflammatory cells were observed. These findings explain the variable microsporidial susceptibility to chlorhexidine, suggesting the crucial role of host immunity. In cases of host immunity, topical chlorhexidine may represent a promising option for the treatment of microsporidial stromal keratitis.
UR - http://www.scopus.com/inward/record.url?scp=85127623080&partnerID=8YFLogxK
U2 - 10.1097/JCMA.0000000000000661
DO - 10.1097/JCMA.0000000000000661
M3 - Review article
C2 - 35383705
AN - SCOPUS:85127623080
SN - 1726-4901
VL - 85
SP - 532
EP - 536
JO - Journal of the Chinese Medical Association
JF - Journal of the Chinese Medical Association
IS - 4
ER -