Uveitis After Microsporidial Keratoconjunctivitis May Not Require Corticosteroids

The average duration of resolution of uveitis associated with microsporidial keratoconjunctivitis (MKC) is longer in patients using eye lubricant and corticosteroids compared with patients using eye lubricant alone, according to a retrospective analysis published in Cornea. Clinicians should exercise caution when prescribing steroids for patients with active corneal lesions, according to the report. 

Researchers reviewed 2212 medical records of patients with microsporidial keratitis between July 2016 and August 2021 and included patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells in the analysis. The team examined demographic and clinical features and management strategies used to treat these individuals and excluded patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis from the analysis. 

Among the study cohort, 171 patients (mean age, 43.8 years; 120 men) had documented KPs or anterior chamber cells. The KPs appeared for a mean 6.9 days (range, 1-30 days) and could be observed on the day of presentation in 48 (28%) of these 171 patients. The superficial punctate keratitis were central and diffuse in 48 and 49 patients, respectively, the report shows.  

Treatment consisted of either lubricant alone (eyes, 78; 45.3%) or combined with topical steroids (eyes, 94; 54.7%). 

The mean duration of resolution of uveitis was longer among patients treated with corticosteroids (15.3 days) compared with participants who did not receive corticosteroid management (12.3 days; P =.007). Presenting visual acuity was 0.26 logarithm of the minimum angle of resolution (logMAR) with a pinhole occluder, which improved to 0.03 logMAR upon resolution (P <.0001). 

“Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions,” according to the researchers. “Incidentally, topical steroids could also be a risk factor for developing MKC which delayed the resolution of associated anterior chamber inflammation as well.”

This study was limited by the retrospective design.