Supplementary Material for: A Rare Microsporidial Infection in Lamellar Corneal Tissue, Following Transepithelial Photorefractive Keratectomy

To report a unique case of microsporidial keratitis over deep anterior lamellar keratoplasty after Trans-PRK surgery that was successfully treated with therapeutic lamellar keratoplasty without recurrence at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The patient presented with recurrent attacks of eye pain, redness, photophobia, and decrease vision. The patient was initially treated as a case of presumed herpetic keratouveitis using antiviral medication and topical steroids with partial improvement. During the last episode, the condition deteriorated and patient underwent therapeutic lamellar keratoplasty. Histopathology indicated an infected graft with evidence of microsporidial infection. The patient was discharged with complete corneal epithelial healing, and no signs of recurrence during follow-up. Microsporidial infection is a rare cause of stromal keratitis that affects both immunocompetent and immunosuppressed patients. Microsporidia should be suspected after surface ablation refractive surgery if the patient presents with recurrent symptoms of keratoconjunctivitis or stromal keratitis that is partially responsive to topical steroid therapy.

本病例报告介绍沙特阿拉伯利雅得市哈立德国王眼科专科医院收治的1例经上皮准分子激光角膜切削术（Trans-PRK）后行深前板层角膜移植术，继发微孢子虫性角膜炎，最终通过治疗性板层角膜移植术成功治愈且无复发的罕见病例。该患者表现为反复发作的眼痛、眼红、畏光及视力下降。患者最初被拟诊为疱疹性角膜葡萄膜炎，予以抗病毒药物及局部糖皮质激素治疗，症状获得部分改善。在末次发作期间，患者病情恶化，遂接受治疗性板层角膜移植术。组织病理学检查显示移植植片存在感染，且可见微孢子虫感染的相关征象。患者出院时角膜上皮完全愈合，随访期间未观察到复发征象。微孢子虫感染是基质性角膜炎的罕见病因，可同时累及免疫功能正常与免疫功能受损患者。若患者在屈光表面切削术后出现反复发作的角结膜炎或基质性角膜炎症状，且经局部糖皮质激素治疗仅部分缓解，则应考虑微孢子虫感染的可能。