Microsporidia and Acanthamoeba: the role of emerging corneal pathogens.

Parasitic organisms are increasingly recognized as human corneal pathogens. A notable increase in both well-defined Acanthamoeba keratitis and a more dramatic increase in reported cases of Microsporidia keratitis have suggested significant outbreaks of parasitic keratitis around the world. Historical and contemporary baselines as well as a familiar associated clinical presentation reinforce the significant outbreak of Acanthamoeba keratitis in the United States. The remarkable rise in cases of Microsporidia keratitis, however, lacks these established baselines and, further, describes a disease that is inconsistent with previous definitions of disease. While a well-defined, abrupt increase strongly suggests temporally related risk factors, most likely environmental, involved in the Acanthamoeba outbreak, the rise in Microsporidia keratitis suggests that increased awareness and improved diagnostic acumen are a significant factor in case ascertainment. Regardless, recent evidence indicates that both parasitic diseases are likely underreported in various forms of infectious keratitis, which may have unrecognized but significant implications in the pathogenesis of both primary protozoal and polymicrobial keratitis. Further understanding of the incidence and interaction of these organisms with current therapeutic regimens and more commonly recognized pathogens should significantly improve diagnosis and alter clinical outcomes.

Precision of three topography instruments in keratoconus subjects.

PURPOSE: To determine the test-retest reliability of three popular and commercially available Placido-ring videokeratography instruments in subjects with keratoconus. METHODS: Nine subjects (16 eyes) with keratoconus of varying degrees of severity had up to four images per eye generated, in random order, from the EyeSys Model II, Dicon CT 200 and the Keratron Corneal Analyzer. Test-retest analyses for the images were sampled at four locations: 1.5 mm nasal, inferior, temporal, and superior from center. The average standard deviation of all points was used to determine the short-term variability of the measurements. RESULTS: The short-term variability (in diopters) of the Dicon, EyeSys, and Keratron was 0.61 to 3.31 D, 0.94 to 1.51 D, and 0.58 to 2.85 D, respectively, for axial distance maps and 1.07 to 6.82 D, 0.79 to 1.77 D, and 1.23 to 3.03 D for tangential curvature maps. CONCLUSION: Results support the notion of a loss in repeatability for all three instruments when corneal irregularity is present, which reduces test-retest reliability.